Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children

Background: A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.Methods: We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year. Results: In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions: We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.

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Can intraoperative ultrasound visualize the closed reduction and elastic intramedullary nail fixation processes of double forearm fractures in children?

Medicine ◽

10.1097/md.0000000000024324 ◽

2021 ◽

Vol 100 (12) ◽

pp. e24324

Author(s):

Xiaodong Yang ◽

Lang Li ◽

Xueyang Tang ◽

Bo Xiang ◽

Tianfu Wen

Keyword(s):

Intramedullary Nail ◽

Closed Reduction ◽

Intraoperative Ultrasound ◽

Forearm Fractures ◽

Fractures In Children

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Functional outcome of crossed Kirschner wire fixation in pediatric supracondylar humerus fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193823 ◽

2019 ◽

Vol 5 (5) ◽

pp. 772

Author(s):

Rahat Zahoor Moton ◽

Adeel Ahmed Siddiqui ◽

Muhammad Naseem ◽

Uzair Yaqoob ◽

Syed Amir Jalil ◽

...

Keyword(s):

Functional Outcome ◽

Kirschner Wire ◽

Humeral Fractures ◽

Treatment Modalities ◽

Class Iii ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Supracondylar Humeral Fractures

Background: Distal humeral fractures are one of the most common types of fractures in children, most of them being supracondylar. Supracondylar fractures are usually caused by trauma, most likely falls. It is an emergency, requiring rapid diagnosis and management to avoid serious complications. Recommended treatment modalities vary from no reduction and immobilization to open reduction and internal fixation. Kirschner wire (K-wire) fixation of displaced supracondylar fractures after closed reduction is a preferred method and is being performed for over 50 years now. This study was conducted to determine the functional outcome of crossed K-wire fixation in pediatric supracondylar fracture.Methods: This prospective study was conducted from May-November 2018 at the department of Orthopedics, Abbasi Shaheed Hospital, Karachi, Pakistan. It was inferred that functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation. It included 83 children with supracondylar fractures. They were treated with percutaneous crossed K-wire fixation. Patients were then followed up to determine satisfactory functional outcome according to Flynn’s criteria. Data entry and analysis was done using SPSS 21.0.Results: Eight-three patients were included. The mean±standard deviation age of this study population was 7.03±3.39 years. Out of the study participants, 47 (56.6%) were males and 36 (43.4%) were females. 71.1% of the patients were of Gartland class II fractures and 28.9% were of Gartland class III. 43.4% had an injury due to fall while playing while 19.3% had fallen from height. 80.7% were found to have a satisfactory functional outcome.Conclusions: It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.

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Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures – a retrospective multicentre study

10.21203/rs.3.rs-1137765/v1 ◽

2021 ◽

Author(s):

Marcell Varga

Keyword(s):

Surgical Intervention ◽

Complication Rates ◽

Distal Forearm ◽

Forearm Fractures ◽

Kirschner Wires ◽

Paediatric Patients ◽

Fractures In Children ◽

Significant Difference ◽

K Wires ◽

Wire Osteosynthesis

Abstract BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius and forearm fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 30 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

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Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽

10.3390/medicina56020079 ◽

2020 ◽

Vol 56 (2) ◽

pp. 79

Author(s):

Ovidiu Adam ◽

Vlad Laurentiu David ◽

Florin George Horhat ◽

Eugen Sorin Boia

Keyword(s):

Closed Reduction ◽

Diagnosis Related Groups ◽

Financial Burden ◽

Treatment Options ◽

Indirect Costs ◽

Forearm Fractures ◽

Titanium Elastic Nail ◽

Fractures In Children ◽

Elastic Nail ◽

The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

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