Anatomic reduction and internal fixation of diaphyseal forearm fractures in adults is considered the treatment of choice to achieve final goal of union and restoration of the limb functions as similar as possible to the prefracture status.This study tries to assess the clinical effectiveness of a new forearm intramedullary nail system (The Be. Te. Forearm Intramedullary Nail System) which offers improved biological and biomechanical features.The study started with brief reference to the anatomical facts of the forearm bones stressing upon certain anatomical considerations including: the radial bow with its crucial importance on the range of forearm motions, the styloid process of ulna with the attached triangular fibrocartilage complex. Anatomy of the interosseous membrane and its functions regarding prevention of proximal migration of radius when the radial head excised, transmission of forces from the radius distally to the ulna proximally in addition to its function in hinge mechanism for rotatory motion of the forearm had been inferred.Biomechanics of the forearm had been described. The axis of pronation-supination (from the center of the radial head to the base of styloid ulna), the forearm anatomical axis (extends from mid-point between epicondyles of humerus and mid-point between styloid processes of radius and ulna) and the relation between them had been discussed.Biomechanics of intramedullary fixation had been shortly discussed. There are two principals of medullary fixation (gliding which includes: flexible intramedullary implants and rigid implants and non-gliding one referred as interlocking system). To characterize the mechanical behavior of an implant and its secondary effect on bone healing, the material from which it is fabricated, the loads imposed on the implant and the geometric features of both the implant and the fracture must be put in consideration. The major features that influence the strength of fixation of intramedullary implant within bone (implant-bone fixation) are: the material and structural properties of the implant, the loads applied to bone-implant construct and the fracture geometry. A brief discussion of the mechanical bases of bone healing had been expressed.The art of internal fixation of fractures utilizing various implants has undergone important and basic changes. Two major approaches are well known to be used for surgical fixation of fractures: The conventional approach depends upon the rigid fixation of fractures and the direct bone healing and the biological approach considering the importance of preservation of soft tissues and careful protection of bone fragments and their vascularity. Intramedullary nailing as a method fixation of diaphyseal fractures of forearm has many advantages including : Minimal surgical trauma, avoiding periosteal stripping, preservation of fracture haematoma in closed nailing technique, fewer loads were put on the implant and more loads afforded on the surrounding cortical bone, early mobilization of the affected limb and lower incidence of refracture after nail removal.Reviewing the literature regarding the use of intramedullary fixation in forearm fractures had been mentioned. Various implants had been used including: K-wires, Steinman pins and Rush pins. Also, the evolution of nails utilized in forearm fractures had been mentioned including: Street nail (1957), Sage nail (1959), Hackethal bundle nailing (1959), Von-Saal square nail (1961), Schneider nail (1971), ForeSight nail (1995) and variable designs of locked nails.The mechanism of injury of the forearm fractures and the causative trauma either direct or indirect had been declared. The study shifted to the clinical and radiological diagnosis of the fractures with a brief hint about the new modalities of investigations as magnetic resonance imaging and computerized scanning.Regarding the patients of the study, 103 adult patients (166fractures) with diaphyseal fractures of the forearm bones were dealt with and they constituted the material of the study.63 patients with both forearm bones fractures.10 patients with radial shaft fractures.3- Assessment of stroke severity using CANS during the first 24 hours of stroke onset and at 21 day after stroke onset.4- Laboratory investigations including, CBC, RBG, liver and kidney function tests, lipid profile, uric acid, CRP and serum cortisol level.5- Serum ferritin level within 24 hours of stroke onset using immunoassay.6- ECG and echocardiography.7- Computed tomography of the brain (C.T).The results showed that:- There was a highly significant difference between improved and deteriorated stroke patients regarding age, and there was no significant difference between the two groups regarding sex and stroke type.- The admission mean, systolic and diastolic blood pressure, RBG level, uric acid and C.T. lesions size were significantly higher in deteriorated stroke patients.- A significant correlation was found between serum ferritin and age of patients.- There was no significant difference in mean level of serum ferritin between male and female patients.- There was no significant difference in the mean level of serum ferritin between ischaemic and hemorrhagic stroke patients.- The mean level of serum ferritin was highly significant, higher in deteriorated stroke patients in comparison with improved stroke patients.- There was a highly significant inverse correlation between serum ferritin level within first 24 hours of stroke onset and stroke severity as assessed by CANS on the first day and at 21 day following stroke onset.- The mean level of serum cortisol was significantly higher in deteriorated stroke patients than in improved stroke patients.- There was no significant correlation between serum ferritin level within first 24 hours of stroke onset and serum cortisol level and CRP.- The mean serum ferritin level was highly significant higher in patients with large CT lesions in comparison with those of medium and small CT lesions.- Significantly high levels of mean serum ferritin level was detected in stroke patients with high random blood glucose, hypertensive stroke patients, cardiac patients and stroke patients with high serum cholesterol and triglycerides levels while there was no significant increase of mean serum ferritin level detected in smoking stroke patients.Conclusion:In conclusion the high serum ferritin level as reliable index of elevated iron stores could accelerate the production of oxygen free radicals in the early period following hypoxic ischaemic episode and the intracerebral hemorrhage which result in greater oxidative stress, massive brain tissue damage and poor outcome after stroke. Ferritin also is linked to several stroke risk factors such as hypertension, diabetes mellitus, atherosclerosis and cardiac disease.Recommendations:- In view of our results, we recommend future larger studies about the role of ferritin in ischaemic and hemorrhagic cerebrovascular stroke.- Serum ferritin measurement should be included in future investigations as a prognostic factor in acute stroke.- Future studies about application of antioxidant drugs and iron chelating agents to reduce the effect of ferritin especially in patients with increased body iron stores and as a prophylactic and active treatment of acute stroke.