Pediatric Both Bone Forearm Flexible Intramedullary Nail: Your Journey from Preparation to Full Recovery
Your child’s surgeon will review their medical history and ensure they are safe for anesthesia. In the week prior to surgery, medications such as blood thinners, aspirin and anti‑inflammatory drugs are usually stopped; parents should inform the care team about all prescriptions, vitamins and supplements. The child must not consume solids or liquids during the 8 hours before surgery, and allergies to medications, anesthesia or latex should be discussed.
The night before surgery, give your child a thorough bath or shower with an antibacterial soap such as Hibiclens and avoid using lotions or creams; remove jewelry and nail polish, and ensure comfortable clothing. Follow fasting instructions by stopping all food after midnight.
On the morning of surgery, repeat the Hibiclens wash to keep the surgical area clean. Do not give your child any food or drink and arrive at the hospital at the instructed time with their medication list and insurance information. They will receive anesthesia and you will meet the surgical team.
After surgery, your child will typically stay in hospital for one to three days. In bed, the forearm should be elevated on pillows to reduce swelling and pain, and pain is treated with regular ibuprofen and paracetamol for the first 4–5 days. A compression bandage or splint is applied, and early mobilization exercises without weight bearing are encouraged after the first week【182127814719129†L169-L178】. For flexible nails, a splint is removed around two weeks and the rods are left in place about eight weeks【146882768816276†L96-L103】.
Your child may perform range‑of‑motion exercises but should avoid lifting or bearing weight through the arm until approximately six weeks post‑surgery. Partial weight bearing is generally allowed at 4–6 weeks and full weight bearing at 6–8 weeks. After the rods are removed (around eight weeks) and the second splint worn for about two weeks, gradual weight bearing resumes and full activity is permitted four weeks later【146882768816276†L96-L103】.
During the first week, keep the operated arm elevated and supported on pillows and inspect the fingers regularly. The arm can be placed in a sling for comfort, but many children prefer it uncovered; early gentle motion of the wrist and fingers is encouraged once pain allows. Caregivers should watch for signs of increasing pain, swelling, numbness or compartment syndrome and contact the clinic if problems arise【326414920163245†L429-L437】.
Follow‑up appointments are usually scheduled two weeks after surgery to remove the initial splint and check the incision, at six weeks to assess healing and discuss weight bearing, at eight weeks for nail removal, and again approximately 10–12 weeks post‑op when the second splint is removed. Subsequent visits may be needed up to six months to monitor bone remodeling and decide on final nail removal.
By eight to ten weeks, most children can perform moderate activities such as light play and school tasks. Once the nails are removed and the second splint discontinued, arm strength and motion improve quickly with gradual weight bearing. Partial weight bearing at 4–6 weeks and early motion help prevent stiffness.
Full return to normal activities, including sports and unrestricted play, usually occurs approximately 12–14 weeks after the initial surgery. Because the rods stay in place for about eight weeks and require a second procedure for removal, plan for a total recovery period of around three months; healing times vary, and clinical and radiographic evaluations guide the timeline.