Comparative Evaluation of Screw Elastic Intramedullary Nailing and Talwarkar Square Nailing in Adult Diaphyseal Forearm Fractures: A Prospective Observational Study

Background: Diaphyseal fractures of the forearm in adults pose a therapeutic challenge due to their impact on forearm function. Elastic intramedullary fixation techniques are increasingly preferred over conventional square nails, yet comparative evidence remains limited. The aim is to compare clinical, radiological, and functional outcomes of screw elastic intramedullary nailing (SEI) and Talwarkar square nailing (TSN) in adult diaphyseal forearm fractures. Material and Methods: This prospective observational study included 60 patients, equally divided into SEI (Group A) and TSN (Group B). Demographic details, fracture characteristics, visual analogue scale (VAS) for pain, complications, and functional outcomes (Anderson/Grace–Eversmann criteria) were assessed. Statistical analysis included chi-square and Fisher’s exact test were applicable. Results: Of 60 patients, 38 (63.3%) were male and 41 (68.3%) had right-sided fractures. Road traffic accidents were the leading mechanism of injury (50%), and the middle third of the forearm was most commonly involved (61.7%). Based on AO/OTA classification, simple ulna fractures (22A1) predominated (58.3%). At final follow-up, most patients reported no or mild pain, with severe pain noted only in the TSN group (n=2). Complications were fewer with SEI, which had no non-unions or infections, whereas TSN recorded one non-union, three delayed unions, and two infections. Functional outcomes were excellent in 24 SEI and 20 TSN cases, with satisfactory recovery in 14 patients overall. Unsatisfactory results occurred only in TSN (n=2). No failures were observed. Conclusion: SEI provides better outcomes over TSN in terms of pain relief, complication profile, and functional recovery, making it a favourable option for treating adult diaphyseal forearm fractures. However the difference was not statistically significant. Keywords: Forearm fractures; Intramedullary nailing; Screw elastic nail; Talwarkar square nail; Functional outcome; Complications.