Stacked Flexible Nailing for Radius Ulna Fractures: Revival of a lost Technique

Introduction: Simultaneous radius and ulna fractures are common in adults and generally osteosynthesis with plating is the treatment of choice. Nailing of such fractures is infrequently advocated. We present our unique technique of radius ulna nailing in adults to achieve closed reduction and early predictable union with minimal or no complications. Case Report: Case 1: 22 year old male with midshaft both bones forearm fracture was treated with stacked nailing. Two 2.5 mm steel elastic nails were used in each radius and ulna. No post-operative splintage was needed and patient was mobilized immediately. Patient was able to go back to work in 2 weeks and at one year follow up he showed excellent functional outcome. Case 2: Fifteen year old boy presented with midshaft both bone fractures secondary to fall from height. He was also treated with stacked flexible nailing. Good stability was achieved and patient was mobilized immediately without any splints. He was able to write his exams which started on 11th day post-surgery and could complete his theory papers. At final follow up both bones united with good callus and no functional limitations. Conclusion: Stacked nailing technique is a good option in midshaft transverse or short oblique fractures of radius and ulna. It allows for early mobilization without brace or splint. With proper patient selection, good results can be obtained by this simple and minimally invasive technique.