29
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study : A STROBE compliant observational study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.

          The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.

          Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.

          Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.

          Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.

          Related collections

          Most cited references24

          • Record: found
          • Abstract: found
          • Article: not found

          State-of-the-art treatment of forearm shaft fractures.

          As the treatment of pediatric forearm shaft fractures has changed extensively over the past 30 years, it is worth discussing the current treatment modalities in these fractures. The recommendations are based on an ongoing evaluation of treatment procedures, problems, complications, and final results going back to 1976. Between 1976 and 1985, the 95.9% of fractures that were treated conservatively were tainted with bad functional results because a significant proportion healed with malalignment. The introduction of elastic-stable intramedullary nailing (ESIN) initiated a definitive change and the opportunity to stabilize unstable fractures with a less invasive method. Apart from some technical problems, the functional results of ESIN are very satisfactory. The external fixator is a good treatment for open, comminuted, or special distal dia-metaphyseal fractures in older children and adolescents. Therefore, we currently have a variety of methods to treat forearm shaft fractures in children using primary definitive fracture care (PDFC). The differentiated use of conservative and surgical measures should minimize final functional sequelae. A well-tried algorithm for this fracture region is outlined.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires.

            This prospective, randomized trial compares the infection rates of Kirschner wires left percutaneously and those buried deep to the skin in a group of patients with isolated distal radial fractures. Percutaneous wires had a significantly greater infection rate than wires which were buried deep to the skin.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children.

              In unstable metaphyseal and diaphyseal forearm fractures the treatment of choice is percutaneous Kirschner wire (K-wire) fixation or elastic stable intramedullary nailing (ESIN), respectively. The optimal treatment for the diametaphyseal transition zone is still a matter of debate.
                Bookmark

                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                February 2020
                14 February 2020
                : 99
                : 7
                : e17763
                Affiliations
                [a ]Surgical Division of the Department of Paediatrics, Medical School, University of Pécs
                [b ]Medical School, University of Pécs
                [c ]Sándor Péterfy Street Hospital and Casualty Centre
                [d ]Department of Anatomy, Medical School, University of Debrecen, Hungary.
                Author notes
                []Correspondence: Gergo Jozsa, Unit of Pediatric Surgery, Department of Pediatrics, Medical Centre, University of Pécs, Jozsef A. str. 7, H-7623 Pécs, Hungary (e-mail: dr.jozsa.gergo@ 123456gmail.com ).
                Article
                MD-D-18-07944 17763
                10.1097/MD.0000000000017763
                7035118
                32049775
                ebb90428-ef92-4ce4-a371-a1b127115763
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 10 November 2018
                : 5 September 2019
                : 3 October 2019
                Categories
                6200
                Research Article
                Observational Study
                Custom metadata
                TRUE

                dia-metaphyseal fracture,esin,k-wire,pediatric trauma,short double elastic nailing

                Comments

                Comment on this article