Closed intramedullary nailing surgery under fluoroscopy (C-Arm) – A new treatment approach for pediatric patients in orthopedic trauma surgery.

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Closed intramedullary nailing under fluoroscopy (C-Arm) is an advanced method widely applied at the International Pediatric Center, Hai Phong International Obstetrics and Pediatrics Hospital. Previously, pediatric patients with fractures requiring surgery underwent open surgery to expose the broken bone for realignment and fixation using various pins, plates, and steel wires. The limitation of this surgical technique is the significant destruction of soft tissue around the bone, leading to risks of infection, delayed bone healing, non-union, prolonged hospital stays, and extended surgery times. After the bone heals, a second surgery is required to remove the fixation devices, leaving unsightly scars and causing fear and trauma for the children. In response to this reality, the surgical team at the International Pediatric Center, Hai Phong International Obstetrics and Pediatrics Hospital has developed and implemented the closed intramedullary nailing technique under fluoroscopy for treating closed fractures, especially for closed fractures of the forearm and supracondylar humeral fractures.

This technique can be imagined as “endoscopic bone surgery” (compared to laparoscopic surgery in gastrointestinal surgery). This technique has many advantages, such as closed reduction and intramedullary nailing fixing the fractured bone through the skin, which does not cause blood loss or destroy soft tissue and periosteum like open surgery, allowing for faster fracture healing, no scarring, and early recovery of limb function. It shortens the surgery time due to the absence of skin incisions, dissection, exposure of the fracture site, and suturing of the incision. With no large incisions, the risk of infection is significantly reduced, and patients do not require extensive antibiotic use, often being discharged early.

Equipped with modern and advanced facilities, along with a highly skilled team of doctors, the Surgery Department at the International Pediatric Center, Hai Phong International Obstetrics and Pediatrics Hospital not only applies this technique for treating distal radius fractures but also for ulna fractures and some cases of diaphyseal fractures of the forearm where closed reduction is feasible. Throughout the treatment and follow-up process, no complications occurred, bones healed well, limb function recovered early, and costs were significantly reduced compared to open surgery. The technique of intramedullary nailing under fluoroscopy for treating various types of fractures in general and forearm fractures in particular is a modern treatment method that applies advancements in science and technology. Patients treated with this method are often very satisfied because limb function can recover early, allowing them to quickly return to their daily activities, with very small surgical scars, ensuring high aesthetic value, helping to minimize fear and trauma in the future for the children.

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