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BackgroundThe objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation.MethodsThirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe median follow-up was 37.3 months (range, 15–53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up.ConclusionsRadial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

Background The coronavirus disease 2019 (COVID-19) pandemic has led to dramatic disruptions to orthopedic services. The purpose of this study is to quantify the reinstatement of elective orthopedic surgeries of our institution in Shanghai, China, and share our first-hand experiences of how this region is managing the post-outbreak period. Methods The number of patients receiving elective orthopedic surgeries was analyzed in the timeframe of 8 months since the start of the pandemic (from January 20 to September 16) and compared with the patients receiving the same treatment during the same period in 2019. And a detailed workflow for handling patients about to receive elective surgeries in the COVID-19 post-outbreak period was described. Results The number of the selective surgeries in the first 3 months only accounted for 31.72% of the same period in 2019 (p = 0.0031), and the ratio reached 97.47% when it came to the last 5 months (p > 0.9999). The selective surgeries even surpassed the pre-epidemic level in months 7 and 8. And the difference of the surgeries was not significant in the whole eight observed months between 2019 and 2020 (p = 0.1526). No health care providers or hospitalized patients in orthopedic departments in Shanghai have been infected nosocomially. Conclusions Elective orthopedic surgeries have been fully recovered from the COVID-19 pandemic in our institution, and the new normalcy established during the post-outbreak period helped this region co-exist with the impact of the virus well. Trial registration Retrospectively registered, registration number: ChiCTR2000039711, date of registration: November 6, 2020

Background Chronic low back pain affects daily activities at home and workplaces and causes a huge economic burden. Current therapeutic options are very limited and the effects of available pharmacological agents are less than satisfactory. While NSAIDs might be effective for the short term and opioids might help with urgent pain relief and improving the life quality, their long-term use is associated with significant side effects and drug misuse or abuse. To seek alternative pharmacological agents for effective treatment, we examined the therapeutic potential of the extracts of Vaccinia variola -inoculated rabbit skin ( Analgecine, abbreviated as AGC ) in patients with chronic low back pain due to degenerative vertebral disorders. Methods In this randomized multi-center double-blind placebo-controlled phase 3 clinical trial (Chinese Clinical Trial Registry number 2009L01498), we enrolled patients (aged 26–70 years) with chronic low back pain for at least 3 months due to degenerative spinal (vertebral) disorders from 7 medical centers in China, and randomly allocated 459 participants to receive oral AGC or placebo for 28 days to study the efficacy and safety of AGC . Randomization was performed according to a centralized randomization schedule, which was blocked by study sites and generated by an unmasked statistician independent of study conduct and data analysis. Both participants and staff at each study site were masked to treatment assignment. The primary efficacy endpoint was the change of the mean pain intensity, based on an 11-point numerical rating scale, between the baseline and the last week of treatment, with the primary efficacy analysis of intention to treat. The ratio between exposed and unexposed groups was designed to be 3:1 in order to increase the likelihood of demonstrating the AGC effect upon repeated measures. Results 347 patients were assigned to receive AGC (4 units/tablet; 2 tablets twice a day) and 112 patients were to take placebo. Among them, 324 patients taking AGC and 112 receiving placebo completed the assessment. Patients receiving AGC reported significant pain relief at the end of week 2 and 3 compared to those taking placebo, with mean reduction of the pain scores as 1.7 vs. 0.9 at week 2 (p vs . 1.2 at week 3 (p AGC -treated patients reported 85 treatment emergent adverse events while 16 patients taking placebo reported 26 events, but no serious side effects were found to be related to AGC treatment. Conclusion Analgecine ( AGC , 8 units twice daily) effectively alleviates chronic low back pain due to degenerative vertebral disorders when compared to placebo and is well tolerated by tested individuals, and can be considered as a first-line treatment for chronic low pain due to degenerative vertebral diseases.

The purpose of this study was to investigate the feasibility and advantages of constructing a novel tissue engineering bone, using β-tricalcium phosphate (β-TCP) and rat bone marrow mesenchymal stem cells (MSCs), modified with human bone morphogenetic protein 2 gene (hBMP2) and human vascular endothelial growth factor 165 gene (hVEGF165), through lentiviral transfection. Both genes were successfully co-expressed in the co-transfection group for up to eight weeks confirmed by enzyme-linked immunosorbent assay (ELISA). After seeding MSCs onto the scaffolds, scanning electron microscopy (SEM) observation showed that MSCs grew and proliferated well in co-transfection group at 7 and 14 days. There was no significant difference among all the groups in hoechst DNA assay for cell proliferation for 14 days after cell seeding (P > 0.05), but the highest alkaline phosphatase (ALP) activity was observed in the co-transfection group at 14 days after cell seeding (p < 0.01). These results demonstrated that it was advantageous to construct tissue engineering bone using β-TCP combined with MSCs lentivirally co-transfected with BMP2 and VEGF165, providing an innovative way for treating bone defects.

Various methods are available to treat the stiff elbow. However, there is no consensus on which one is most useful. This study involves the effects of combination of arthrolysis by lateral and medial approaches and hinged external fixation in the treatment of stiff elbow.We treated 12 patients with stiff elbows using a combination of arthrolysis by lateral and medial approaches and hinged external fixation. The arthrolysis was applied to the elbow for complete soft-tissue release, and the hinged external fixation mainly for rehabilitation and stability of the elbow after arthrolysis. With the help of the hinged external fixation, nonsurgical treatment including exercises was effectively performed to maintain the stability and the results of arthrolysis. Before surgery, the mean extension was -35 degrees and the mean flexion 70 degrees. One patient had a loss of 70 degrees in pronation.Satisfactory follow-up was given to 11 patients with the mean length of 15 month. The mean postoperative extension was -8 degrees whereas flexion 122 degrees. Two of 11 patients had a transient ulnar paresthesia and returned to normal after 8-month follow-up. The loss of pronation in one patient reduced to 30 degrees afterward. There were no complicating infections. All patients reported satisfactory effect.The combination of arthrolysis by lateral and medial approaches and hinged external fixation in the treatment of stiff elbow is safe and effective.

The objective of the present investigation was to characterize the antibacterial and osteogenic properties of plasma sprayed silver-containing hydroxyapatite (HA/Ag) coating in vitro. HA/Ag coating was deposited via vacuum plasma spraying. The concentration of silver ions released from HA/Ag coating, the efficacy of the HA/Ag coating against bacterial biofilm development, the effect of the HA/Ag coating on early adhesion and ossification of osteoblast cells in vitro was measured. The silver ion concentration released from the HA/Ag coating was between the minimum inhibitory concentration to bacteria and the cytotoxic concentration. Bacterial biofilm inhibition studies indicated an antibacterial activity on the HA/Ag coating surface when compared with hydroxyapatite (HA) coating alone. Moreover, it was demonstrated that osteoblast cell adhesion and mineralization occurred on the HA/Ag coating surface during the testing period. We conclude that the vacuum plasma sprayed HA/Ag coating possesses good antibacterial capability and osteogenic properties in vitro and represents a promising candidate for coating orthopedic implants.

We report a 52-year-old female patient with a 2-year history of local neck pain, decreased cervical spine rotation, progressive numbness and weakness of both arms. Preoperative, dynamic X-rays, computed tomography, three-dimensional computed tomography demonstrated a displaced Os odontoideum with irreducible Subluxation of C1/2. We used a single transoral approach release, reduction using an assistance of skull traction, bone fusion and stabilization in the treatment of Os odontoideum with irreducible alantoaxial dislocation. Postoperative, the patient was free of all symptoms and X-rays taken showed a stable fusion of C1/2 at 6th postoperative month. This technique in the treatment of Os odontoideum with irreducible alantoaxial dislocation is atraumatic and effective. And preoperative dynamic X-rays, computed tomography, three-dimensional computed tomography and MRI scans provided an invaluable aid to select this operative procedure.

Recent evidence has demonstrated that microRNAs (miRNAs) are involved in the proliferation and metastasis of osteosarcoma. Using miRNA microarray and functional screening methods to compare miRNA expression profiles in osteosarcoma cell lines treated with Trichostatin A (TSA), overexpression of miR-542-5p was determined to be involved in the proliferation of osteosarcoma. We used isobaric tags for relative and absolute quantitation (iTRAQ) and nanoscale liquid chromatography-mass spectrometry (NanoLC-MS/MS) to identify differentially expressed proteins in MNNG/HOS and U2OS osteosarcoma cell lines transfected with miR-542-5p; in both cell lines, seven proteins were downregulated, and nine were upregulated. HUWE1 was found to be a direct target of miR-542-5p in both osteosarcoma cell lines, and was negatively correlated with miR-542-5p levels in human osteosarcoma tissues. Moreover, the expression of miR-542-5p was upregulated in human osteosarcoma tissue compared with non-tumor adjacent tissue. Kaplan-Meier analysis revealed that overexpression of miR-542-5p predicted poor prognosis for osteosarcoma patients. Taken together, our results indicated that miR-542-5p plays a critical role in the proliferation of osteosarcoma and targets HUWE1.

Open arthrolysis is an effective way to treat elbow stiffness. However, previous approaches led to significant surgical trauma. The goal of the current study was to evaluate the outcome of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation to treat elbow stiffness. A total of 18 patients (18 elbows) with elbow stiffness were retrospectively reviewed. The same inclusion and exclusion criteria were used for all patients. Preoperatively, the mean flexion arc was 43°±28° and the mean Mayo Elbow Performance Score was 62 points. Limited medial and lateral approaches were used to provide safe and complete arthrolysis. The other protocols included ulnar nerve transposition, medial epicondyle osteotomy, radial head resection, ligament repair, and hinged external fixation. Patients were encouraged to begin early rehabilitation 24 hours after surgery. At a mean follow-up of 20 months, the flexion arc improved to 130°±11° and the mean Mayo Elbow Performance Score was 97 points (15 excellent, 3 good). One patient had elbow instability, but function met the requirements of his daily life. Transient ulnar nerve palsy without infection occurred in 4 patients. With limited medial and lateral approaches, elbow stiffness can be treated effectively with open arthrolysis. This method is trauma controlled. Furthermore, a hinged external fixator can provide sufficient and safe rehabilitation. The use of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation is an effective and safe method to treat elbow stiffness. [ Orthopedics. 2015; 38(6):e477–e484.]

The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauve–Kapandji (S–K) procedure. This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. The mean patient age was 35 (range 19–45) years. Mean time to reconstruction was 2.5 (range 0.5–4) years. Mean postoperative pronation was 74°; mean postoperative supination was 80°. Overall results were excellent/good in seven patients, fair in one, and poor in one. No bone bridge was formed between the pseudarthrosis in any patient. Two patients had neurapraxia. Moderate pain and snapping occurred in one patient during movement at the ulnar amputation site. This modification of the S–K procedure can restore rotation of the forearm after hand revascularization; as such, it provides an alternative salvage procedure.

Thoracic Outlet Syndrome (TOS) is a common surgical disease, which will cause certain symptoms like neck-shoulder pain, headache, numbness of the upper limb and so on. Many of those symptoms are derived from brachial plexus entrapment. That syndrome is hard to diagnose in clinic. We need some direct evidence of the disease. Yet, the visualization of peripheral nerve like brachial plexus is still a tough problem. Presently, corresponding researches usually built their foundation on cadaver autopsy. In the study, a three dimensional (3-D) model of brachial plexus and its surrounding structures was established by segmentation of Chinese visible human (CVH) data. As a result, it is found brachial plexus went through a narrow tunnel surrounded by bone, muscle and tendon-like tissues. And, at its root and division sections that “tunnel” has been greatly compromised. Our findings indicate the potential sources and location of the disease, which may help to clinical diagnosis and treatment.

Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap.Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm x 7 cm to 24 cm x 10 cm in size in hand and forearm after injured by motor vehicle accidents (2 cases) or crushed by machine (8 cases). Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein respectively. The flap sizes ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months' follow-up.Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.

To analyze the influence of muscle tension in the histological changes of the skeletal muscle.Fifty-four Sprague-Dawley (SD) rats were randomly divided into 3 groups. The left gastrocnemius muscles of the rats were dissected with only the neurovascular pedicles intact; the tibial nerves were cut and immediately repaired by epineurial suture. Then the Achilles tendons were isolated and treated accordingly; the Achilles tendon were lengthened by 0.5 cm in lengthened group, shortened by 0.5 cm in shortened group and left alone in normal (control) group. In the 2nd, 4th and 8th weeks after operation, the specimens were taken from gastrocnemius muscle for histological study by light and electron microscope.In comparison between the groups, the gastrocnemius muscles in the shortened group showed less severe muscle atrophy and connective tissue proliferation, bigger diameter and cross section area of the muscle fibre than those in the normal and lengthened groups in all the postoperative periods.A proper high tension of the muscle may decrease the muscle dystrophy and stops the histological changes of skeletal muscle by having much longer fibre length and bigger cross sectional area. Also increases the muscle function as the muscle active force-generating range is determined by muscle fibre length, while maximum muscle force is determined by physiologic cross-sectional area.

We proposed a novel combined gene therapy of human vascular endothelial growth factor 165 gene (hVEGF165) and human bone morphogenetic protein 2 gene (hBMP2) for bone regeneration by lentivirus-mediated co-transfection of both genes into rat bone marrow-derived mesenchymal stromal cells (MSCs). Both genes were successfully co-expressed in MSCs confirmed by real-time PCR and ELISA. And the alkaline phosphatase activity of MSCs was significantly augmented by the co-transfection with both genes than any single gene transfection (P < 0.01). These results demonstrated the feasibility of the combined gene therapy by using MSCs lentivirally co-transfected with hVEGF165 and hBMP2 for bone regeneration.

Elbow stiffness is one of the difficult disorders because of its nature being vulnerable to contracture. The conservative treatment should be recommanded firstly, then the surgical intervention is indicated after the failure of conservative attempt. From 2010 to 2015, we have been treating 258 cases who suffered elbow stiffness in our center. The causes of stiff elbows included trauma, rheumatoid arthritis, burn, degenerative disease, and congenital malformations. We would like to share our cases and experiences with the peers worldwide, and we also will learn more from the communication. Preoperative assessment (1) Any surgical history is important, the details (including the incision, internal fixation, nerve intervention) would guide the plan of surgery. (2) An overall physical examination should be amphasized every time the patient comes to the office, including extension and flexion deficiency, rotation limited or not, stability, skin contracture, and nerve symptoms. All these could become a puzzle during operation. (3) Radiography assessment (X ray, CT scan, MRI) aims to address the heterotrophic ossification, malunion, joint space, and target pathologies such as synovium. Keep in mind The general joint condition and patient's expectation are the two key points to surgical indication. Surgical techniques (1) A single lateral or medial approch is always sufficient for moderate elbow stiffness. We recommaned the combined medial and lateral approaches rather than posterior approach to treat severe stiff elbows, in which the lateral to reach anterior and medial to reach posterior. (2) General release and clearance should cover the hypertrophic capsule, humeroradial joint, triceps, olecranon fossa, fossa coronoidea, HO. (3) The anterior bundle of the medial collateral ligament (AMCL) and lateral ulnar collateral ligament should be left intact to prevent instability while we further release the ligament contracture. Intraoperative examination is necessory to detect the stability of the elbow, the ligament repair is very important for a functional joint. (4) We recommand ulnar nerve anterior transposition preventively. (5) We believe it reasonable and helpful to adopt a hinged external fixator in severe cases, it provides extra-stability and security for repaired ligaments, facilitate rehabilitation, and a less painful situation leads to more effective outcoming. Keep in mind Aiming to handle the target pathologies blocking mobility as well as the sufficient structures maintaining stability. Patient education and rehabilitation (1) Preoperative education is very important, it is the doctor's responsibility to notify the importance of rehabilition. (2) We encourage early-stage exercises after surgery, starting from the first postoperative day, which follow a logical sequence of progression with some flexibility in application. The exercises consist of active, assisted, and passive elbow flexion and extension movements. The progressive exercise program is continued for as long as three months after the surgery. (3) During the interval of each exercise session, a compressive cryotherapy device is encouraged to be applied to relieve pain. We have performed a prospective, single-blinded, randomized controlled study to investigate the effect of cryotherapy after elbow arthrolysis. VAS scores were significantly lower in the cryotherapy group during the first 7 postoperative days, both at rest and in motion. (4) The applying of drains and indomethacin aims to reduce the pain as well as the incidence of edema and hetertopic ossification. Keep in mind The patient education and rehabilitation should be throughout the treatment, it will decide the final outcome.

To study the clinical effect of tractive reduction with external fixator and arthroscopically assisted treatment for tibial plateau fractures.From February 2003 to January 2005, a total of 26 cases with tibial plateau fractures were reviewed. There were 4 cases of type I fracture, 5 type II, 4 type III, 6 type IV, 5 type V and 2 type VI based on Schatzker criteria. Before operation, X-ray examination and CT scanning were done. During operation, the dissociative fragments were reconstructed by tractive reduction with external fixator arthroscopically and fixated with screws or plates.All the fractures were healed within 1.5 - 4 months, with no severe complications such as poor wound healing, infection or osteofascial compartment syndrome. All patients that were followed up for 7 - 21 months (mean, 16 months) showed no traumatic osteoarthritis, inversion or eversion of the knee. According to the Rasmussen scoring system, the outcome was excellent in 11 cases, good in 13 and fair in 2, with total score of 27 +/- 2.As for Schatzker type I - VI tibial plateau fractures, tractive reduction with external fixator and arthroscopically assisted treatment is characterized by minimal invasion, fast fracture healing. It broadens operative interspace of articular cavity, improves accuracy of reduction, is beneficial for knee joint function to recover.

To investigate the effects of nano-bionic surface modification in improving the blood compatibility of small intestinal submucosa (SIS) used as engineering vascular scaffolds.SIS films were obtained from pig and underwent nano-bionic surface modification with plasma initiation technique. Scanning electron microscopy (SEM) was used to observe the morphological features, including water contact angle, of the SIS films after nano-bionic surface modification. Modified SIS films were immersed into human platelet-rich plasma for 10 s and then observed for the adhesion of platelet on the surface thereof. Another modified SIS films were immersed into anticoagulant human blood to test the prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT). Twenty dogs were randomly divided into 2 equal groups to undergo cutting of bilateral femoral arteries and anastomosis with tube-like scaffolds made of modified or un-modified SIS films. Color Doppler ultrasonography was used to examine the blood flow 1, 3, and 6 weeks after operation. The dogs were killed in batches 2 and 6 weeks after operation to take out the SIS vessels to observe the existence of mural thrombus and undergo microscopy.SEM showed island-like and groove-like surface morphology in the modified SIS films, and the water contact angle decreased from 105.3 degrees to 62.0 degrees. After treatment by anticoagulant human blood the PT, APTT, and TT of the modified SIS films increased from 30.5 s, 9.8 s, and 13.6 s to 81.5 s, 39.6 s, and 50.2 s respectively. SEM showed that the number of adhering platelets was less on the surface of the modified SIS films than on the surface of un-modified SIS films. Animal experiment showed that 4 blood vessels anastomosed with un-modified SIS tube became completely thrombosed within 3 hours, and the other 6 became completely thrombosed 3 days later, and the 10 blood vessels anastomosed with modified SIS tube remained patent till 6 weeks after operation. Gross observation showed that the implanted scaffolds made of modified SIS films had become biological tube-like 2 weeks after operation, and became integrated tubes with their inner walls covered with endothelial cells 6 weeks post-operatively.Nano-bionic surface modified SIS film possesses good and persistent antithrombogenicity and shows excellent blood compatibility.

Objective To introduce a new technique of 1-stage reconstruction for thumb loss complicated by thumb–index web space contracture and to report its clinical effectiveness. Methods From November 1994 to September 2004 there were 11 patients with thumb loss and contracture in the thumb–index web space who had a combined transplantation of free tissues to reconstruct the missing thumb and to rebuild the web space. The reconstructive procedure used the second toe and the anterolateral thigh flap in 5 patients, the second toe and the scapular flap in 2, the big toe wraparound flap and the anterolateral thigh flap in 3, and the big toe wrapround flap and the scapular flap in 1. The 2 independent free tissues were connected together by a vascular combination to form an assembly with 1 common vascular pedicle, which then was anastomosed to the selected vessels in the recipient hand. In this vascular series the dorsalis pedis artery and the greater saphenous vein served as the common vascular pedicle of the flap transfers and the radial artery and the cephalic vein provided the recipient vessels. The outcomes of the reconstructions were evaluated using the Michigan Hand Outcomes Questionnaire. Results The flaps survived completely in all patients except 1. In this patient a small area in the distal part of the transplanted anterolateral thigh flap became necrotic but healed after dressing changes without the need for further surgical intervention. A mean follow-up period of 3.6 years showed a mean increase of 4.3 cm in the width of the thumb–index web space and a considerable improvement in overall hand function was noted on the Michigan Hand Outcomes Questionnaire with effect sizes of greater than 3 (large effect) in all domains. Conclusions Combined transplantation of the second toe or the big toe wraparound flap and a free skin flap is suitable to reconstruct a missing thumb and repair the associated skin defect in the adjacent thumb–index web space. We found good functional recovery and an acceptable appearance in this series of patients.Type of study/level of evidence: Therapeutic, Level IV. Type of study/level of evidence Therapeutic, Level IV.

Objective: This study was designed to evaluate the efficacy of the treatment of diaphyseal fractures of the forearm using the ForeSight® forearm interlocking intramedullary nail. Design: Retrospective study. Setting: University-affiliated teaching hospital. Patients: Eighteen patients with 32 displaced diaphyseal forearm fractures were identified. Intervention: All fractures were treated with the Foresight® forearm interlocking intramedullary nail. Eighteen fractures were stabilized with static interlocking technique. Main Outcome Measures: The assessment of patients was based on the time to union, the functional recovery, and the incidence of complications. Physical capability was evaluated by using the rating system of Grace and Eversmann. Patient-rated outcome was assessed by completion of the Disability of Arm Shoulder Hand questionnaire (DASH). Results: All fractures healed with the index procedure. The average time to union for fractures utilizing a closed technique was 10 weeks 7-12 ; for fractures using an open reduction technique, 15 weeks. 10-21 The mean pronation was 62 (range, 0-96) degrees, and the mean supination was 80 (range, 0-105) degrees. Compared with the normal arm, the mean loss of rotation of the forearm was 32 (range, 5-162) degrees. Using the rating system of Grace and Eversmann, 13 patients had an excellent or good result, 3 had an acceptable result, and 2 had an unacceptable result. Using the patient-rated functional questionnaire, the mean DASH of 19 (range, 4-72) points at the time of the most recent follow-up indicated a mild-to-moderate impairment. There were 7 postoperative complications. The incidence of complications was 22% (7/32). One cross-union between forearm bones occurred in a patient with a closed head injury and high-energy trauma. Two nondriving end screws of the ulna nail backed out causing wrist pain and had to be removed. There were 4 superficial infections occurring all in the fractures that necessitated an open reduction technique. The overall rate of infection was 12.5% (4/32). Three patients who presented with an open fracture needed a skin graft to cover the open wound. Conclusions: Forearm interlocking intramedullary nailing is an acceptable method to stabilize displaced diaphyseal forearm fractures in adult.