Diaphyseal forearm fractures without fluoroscopy: Titanium elastic nailing system (TENS): A paediatric case series from Nepal.

In resource-limited settings such as rural Nepal, the lack of intra-operative fluoroscopy often forces clinicians to choose between suboptimal conservative management or referral to distant centres. Our case series presents the feasibility of the titanium elastic nailing system for displaced childhood both-bone forearm fractures using tactile feedback and portable radiography instead of a C-arm. While the rate of open reduction was higher than in a fluoroscopy-guided series (2/9 for radius, 4/9 for ulna), all cases achieved stable intramedullary placement and clinical union. This approach offers a viable alternative for maintaining surgical standards in so-called 'blind' settings.