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

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.

scholarly journals Intramedullary Nailing of Both Bone Forearm Fractures in Children by Rush Nails and Titanium Elastic Nails

2018 ◽  
Vol 4 (1) ◽  
pp. 10-15
Author(s):  
Rajeev Dwivedi ◽  
Ruban Joshi ◽  
Subin Byanjankar ◽  
Sagar Panthi ◽  
Rahul Shrestha ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Forearm Fracture ◽  
Complication Rates ◽  
Forearm Fractures ◽  
Multiple Fractures ◽  
Fractures In Children ◽  
Group Outcomes ◽  
Limb Injuries ◽  
Significant Difference ◽  
Elastic Nails

INTRODUCTION: Forearm fractures are common upper limb injuries among children and usually treated nonoperatively. Failure of nonoperative treatment, open injuries and multiple fractures are the indications for surgery in paediatric both bone forearm fractures.  Intramedullary (IM) nailing is considered as minimally invasive procedure with excellent to fair outcomes but it is not free of complications. We reviewed the results and compared the outcomes of IM fixation by Rush nails with titanium elastic nails (TENs), to understand the risks and complications associated with this procedures. MATERIAL AND METHODS: We performed a retrospective review of all paediatric patients treated for diaphyseal forearm fractures from January 2011  to  December  2015.  Complications  were  classified  according  to  modified  Clavien-Dindo  complication classification system. Outcomes were graded depending upon complication grade along with range of motion of forearm. RESULTS: There was no statistically significant difference for mean time to fracture union between the Rush nailing (10.56 weeks ) group and TENs nailing group (9.85weeks) (P = 0.43). There was no statistically significant difference in outcomes between Rush nailing and TENs nailing group p=0.65. In Rush nailing group outcomes were excellent in 16 (64%), good in 7(28%), fair in 2( 8%) patients and no poor outcome were noted. In TENs nailing group outcomes were excellent in 11 (55%) , good in 6 (30%), fair in 3 (15%) patients and no poor outcomes were noted.  CONCLUSION: Fixation of pediatric forearm fractures by intramedullary Rush nails and titanium elastic nails (TENs) are minimally invasive procedures and results are excellent to fair with acceptable complication rates. Since Rush nails are easily available and affordable in developing countries like ours we can prefer Rush nails for intramedullary fixation of paediatric forearm fracture when indicated.   Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 10-15

scholarly journals 712. Activity of Exebacase (CF-301) Against Methicillin-Resistant Staphylococcus aureus (MRSA) Biofilms on Orthopedic Kirschner Wires

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S320-S320
Author(s):  
Melissa J Karau ◽  
Suzannah Schmidt-Malan ◽  
Jayawant Mandrekar ◽  
Dario Lehoux ◽  
Raymond Schuch ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Bactericidal Activity ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Kirschner Wires ◽  
Carrier Solution ◽  
Time Points ◽  
Significant Difference ◽  
Peptidoglycan Cell Wall ◽  
The Media ◽  
K Wires

Abstract Background Orthopedic foreign body-associated infection can be difficult to treat due to the formation of biofilms protecting microorganisms from both antimicrobials and the immune system. Exebacase (EXE) is a phage-derived lysin which acts as a direct lytic agent by hydrolyzing the peptidoglycan cell wall of Staphylococcus aureus. In this study, the activity of EXE was evaluated in comparison to daptomycin against MRSA biofilms on orthopedic Kirschner wires (K-wires). Methods MRSA strain IDRL-6169 was studied; it has a MIC of 0.5 µg/mL for both daptomycin (DAP) and EXE. Biofilms were formed in 1 mL of 106 cfu/mL tryptic soy broth on 0.5x0.1 mm threaded stainless steel K-wires for 10 hours, after which the wires were removed from the media and placed into 0.04 mL of either DAP or EXE at 0 (vehicle only), 0.098, 0.98, or 9.8 mg/mL. DAP+EXE was also tested, each at 0.098 mg/mL. Bacteria were quantified after 0, 2, 4, 8, and 12 hours of incubation at 37ºC. Testing was performed in triplicate. Results were reported as log10 cfu/K-wire reduction relative to vehicle alone. A 3-log10 cfu/K-wire reduction was considered bactericidal. P-values were calculated using Kruskal–Wallis. Results The bacterial burden of vehicle alone ranged from 5.49- to 6.33-log10 cfu/K-wire at all time points. Bacterial reductions for each treatment compared with carrier solution are shown in the table. DAP showed no bactericidal activity. EXE showed bactericidal activity at all concentrations at all time points studied except 0.098 mg/mL at 8 hours. There was no significant difference between EXE at 0.098 and 0.98 mg/mL at any time point but EXE at 9.8 mg/mL did show superiority over the lower concentrations. DAP+EXE 0.098 mg/mL was bactericidal at all time points. Conclusion EXE showed a rapid effect against MRSA biofilms on orthopedic K-wires apparent within the first 2 hours of exposure and was more active than daptomycin alone at the same concentrations. Disclosures All authors: No reported disclosures.

Plaster cast treatment for distal forearm fractures in children

2020 ◽  
Vol 29 (2) ◽  
pp. 179-186
Author(s):  
Domenico Ravier ◽  
Ilaria Morelli ◽  
Valentina Buscarino ◽  
Chiara Mattiuz ◽  
Luca M. Sconfienza ◽  
...  
Keyword(s):  
Plaster Cast ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Distal Forearm Fractures

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

2019 ◽  
Vol 36 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Anniek C Epema ◽  
Mariëlle J B Spanjer ◽  
Lieselotte Ras ◽  
Johannes C Kelder ◽  
Marieke Sanders
Keyword(s):  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Conventional Radiography ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Predictive Values ◽  
Pain Scores ◽  
Fractures In Children ◽  
Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

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