Comparıson Of Platıng And Tıtanıum Elastıc Naıl Fıxatıon For Surgıcal Treatment Of Pedıatrıc Both-Bone Forearm Fractures

Yıl 2018, , 64 - 68, 02.07.2018

Erdinç Genç , İsmet Yalkın Çamurcu , Erdal Eren

https://doi.org/10.30565/medalanya.364191

Cited By: 1

Öz

Aim: Plate fixation and titanium elastic nailing are conventional surgical treatment modalities for both-bone forearm fractures in children. The purpose of this study is to assess the functional and radiographic results of these techniques and compare with literature. 

Patient and Methods: We evaluated data of 36 children retrospectively. Twelve of the patients (group 1; 1 girls, 11 boys, age range 9-15 years) were treated by open reduction plate fixation and 24 of the children (group 2; 3 girls, 21 boys, age range 9-14 years) were treated by closed reduction intramedullary nailing. Mean total time from fracture until the surgery was 4.3 and 6.1 days in group 1 and 2, respectively. We compared the groups according to union duration, the number and the severity of the complications and clinical outcomes according to Price criteria.

Results: Mean follow-up duration was 22.0 months in group 1 and 19.7 months in group 2. Mean age was 13.0±1.2 years and 11.7±1.6 years in group 1 and 2, respectively. According to Price criteria, we obtained no poor outcomes in both groups. The rate of excellent outcome was 75% and 87.5 % in group 1 and 2, respectively. Union was obtained in 7.6 weeks and 6.7 weeks in group 1 and 2, respectively; this difference was statistically significant (p<0.001). The rate of major complication was 8.3% in group 1. There were none in group 2. 

Conclusion: According to our results, a favorable technique for pediatric both-bone forearm fractures requiring surgical treatment may be titanium elastic nailing because of better clinical outcomes and fewer and less severe complications. 

Anahtar Kelimeler

titanium elastic nail, pediatrics, plate, bothbone forearm

Pediatrik Önkol Çift Kırıklarında Plak Osteosentez Ve Titanyum Elastik Çivi Tedavilerinin Karşılaştırılması

Öz

 Amaç: Bu çalışmanın amacı cerrahi tedavi gerektiren çocukluk çağı önkol çift kırıklarında yaygın kullanılan iki yöntem olan plak osteosentez ve titanyum elastik çivi kullanımın fonksiyonel ve radyografik sonuçlarının değerlendirilmesi ve literatürdeki verilerle karşılaştırılmasıdır. 

Hastalar ve Yöntem: Düzenli takipleri yapılan 36 hasta geriye dönük olarak değerlendirildi. Bu hastaların 12’sine (grup 1; 1 kız, 11 erkek; yaş dağılımı 9-15 yaş) açık redüksiyon plak-vida osteosentez, 24’üne (grup 2; 3 kız, 21 erkek; yaş dağılımı 9-14 yaş) kapalı redüksiyon intramedüller çivileme yapıldı. Yaralanmadan cerrahi müdahaleye kadar geçen ortalama süre grup 1’de 4.3 gün, grup 2’de 6.1 gün idi. Gruplar kaynama süresi, komplikasyon sayısı ve ciddiyeti ve Price kriterlerine göre değerlendirilen klinik sonuçlarına göre karşılaştırıldı. 

Bulgular: Hastaların takip süresi Grup 1’de 22.0 ay, Grup 2’de 19.7 aydı. Hastaların ortalama yaşı Grup 1’de 13.0±1.2, Grup 2’de 11.7±1.6 idi. Price kriterlerine göre her iki grupta da kötü sonuç saptanmadı. Grup 1’de mükemmel sonuç oranı %75 iken Grup 2’de mükemmel sonuç oranı %87.5 olarak saptandı. Grup 1’de kaynama süresi 7.6 hafta, Grup 2’de kaynama süresi 6.7 hafta olarak gözlendi; bu fark istatistiksel olarak anlamlı idi (p<0.001). Grup 1’de major komplikasyon oranı %8.3 olarak saptanırken Grup 2’de major komplikasyon saptanmadı. 

Sonuç: Sonuçlarımıza göre cerrahi tedavi gerektiren çocukluk çağı ön kol çift kırıklarında öncelikli tedavi yöntemi olarak gerek klinik sonuçlarının daha iyi olması gerekse komplikasyon sayısı ve ciddiyetinin daha az olması nedeniyle titanyum elastik çivi uygulaması tercih edilebilir.

Anahtar Kelimeler

titanyum elastik çivi, pediatri, plak, önkol kırıkları

Kaynakça

• 1. Cheng JC, Ng B, Ying S, Lam P. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. Journal of Pediatric Orthopaedics. 1999;19(3):344-50.
• 2. Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. 2007;38(8):913-22.
• 3. Creasman C, Zaleske DJ, Ehrlich MG. Analyzing Forearm Fractures in Children. Clin Orthop Relat Res. 1984;188:40-53.
• 4. Feldkamp G, Daum R. Langzeitergebnisse kindlicher Unterarmschaftbrüche. Hefte Unfallheilk. 1978;132:389-92.
• 5. Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res. 1979;139:114-20.
• 6. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. Journal of Pediatric Orthopaedics. 2006;26(6):827-34.
• 7. Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury. 2005;36(1):S25-S34.
• 8. Bhaskar A, Roberts J. Treatment of unstable fractures of the forearm in children. Bone & Joint Journal. 2001;83(2):253-8.
• 9. Flynn JM, Waters PM. Single-bone fixation of both-bone forearm fractures. Journal of Pediatric Orthopaedics. 1996;16(5):655-9.
• 10. Yung PSH, Lam CY, Ng BKW, Lam TP, Cheng JCY. Percutaneous transphyseal intramedullary Kirschner wire pinning: a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children. Journal of Pediatric Orthopaedics. 2004;24(1):7-12.
• 11. Fernandez F, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing. Injury. 2005;36(10):1210-6.
• 12. Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. Journal of Pediatric Orthopaedics. 2010;30(4):313-9.
• 13. Schemitsch E, Richards R. The effect of malunion on functional outcome after plate fixation of. J Bone Joint Surg Am. 1992;74:1068-78.
• 14. Gustilo R, Anderson J. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. JBJS. 1976;58(4):453-8.
• 15. Verstreken L, Delronge G, Lamoureux J. Shaft forearm fractures in children: intramedullary nailing with immediate motion: a preliminary report. Journal of Pediatric Orthopaedics. 1988;8(4):450-3.
• 16. Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. Journal of Pediatric Orthopaedics. 2005;25(3):309-13.
• 17. Yung S, Lam C, Choi K, Ng K, Maffulli N, Cheng J. Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children. J Bone Joint Surg Br. 1998;80(1):91-4.
• 18. Van der Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. Journal of Pediatric Orthopaedics. 1998;18(1):9-13.
• 19. Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. Journal of Pediatric Orthopaedics. 2008;28(4):403-9.
• 20. Luhmann SJ, Gordon JE, Schoenecker PL. Intramedullary fixation of unstable both-bone forearm fractures in children. Journal of Pediatric Orthopaedics. 1998;18(4):451-6.
• 21. Huber RI, Keller HW, Huber PM, Rehm KE. Flexible intramedullary nailing as fracture treatment in children. Journal of Pediatric Orthopaedics. 1996;16(5):602-5.
• 22. Wyrsch B, Mencio GA, Green NE. Open reduction and internal fixation of pediatric forearm fractures. Journal of Pediatric Orthopaedics. 1996;16(5):644-50.
• 23. Lascombes P, Prevot J, Ligier J, Metaizeau J, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. Journal of Pediatric Orthopaedics. 1990;10(2):167-71.
• 24. Cullen MC, Roy DR, Giza E, Crawford AH. Complications of intramedullary fixation of pediatric forearm fractures. Journal of Pediatric Orthopaedics. 1998;18(1):14-21.
• 25. Fernandez F, Langendörfer M, Wirth T, Eberhardt O. Failures and complications in intramedullary nailing of children’s forearm fractures. Journal of children's orthopaedics. 2010;4(2):159-67.
• 26. KC BB, Lamichhane N, Parajuli SP, Maharjan S. Intramedullary Nailing System in Unstable Both Bone Diaphyseal Fractures in Children. Kathmandu Univ Med J. 2017;59(3):207-11.
• 27. Slongo TF. Complications and failures of the ESIN technique. Injury. 2005;36(1):S78-S85.
• 28. Kruppa C, Bunge P, Schildhauer TA, Dudda M. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases. Medicine. 2017;96(16).
• 29. Beaupré GS, Csongradi JJ. Refracture risk after plate removal in the forearm. Journal of orthopaedic trauma. 1996;10(2):87-92.
• 30. Deluca P, Lindsey R, Ruwe P. Refracture of bones of the forearm after the removal of compression plates. JBJS. 1988;70(9):1372-6.