scholarly journals Osteosynthesis with Kirschner wires in the treatment of unstable forearm fractures in children

2002 ◽  
Vol 55 (3-4) ◽  
pp. 140-145 ◽  
Author(s):  
Dusan Maric ◽  
Lazar Petkovic ◽  
Vladimir Tomasevic ◽  
Ljubomir Bajic ◽  
Djordje Gajdobranski ◽  
...  
Keyword(s):  
Forearm Fractures ◽  
Percutaneous Pinning ◽  
Older Children ◽  
Kirschner Wires ◽  
Manual Reduction ◽  
Fractures In Children ◽  
Short Period ◽  
Both Bones ◽  
Plaster Immobilization ◽  
Unstable Fractures

Introduction Forearm fractures make 13-18% of all injuries of the upper extremities in children. Most of them are older than 6 years. The degree of tolerance is different but children younger than 8 years can tolerate 15-20 degrees of angulation, 45 degrees of inadequate rotation and total displacement. Older children can tolerate angulation of10 degrees, 30 degrees of in adequate rotation and complete dislocation. Material and methods Over a period of five years (1995-2000) 54 children with forearm fractures (22 stable and 32 unstable fractures) were treated at the Pediatric Surgery Clinic in Novi Sad. Closed reduction and percutaneous pinning were treatments of choice in 19 patients with unstable fractures: 7 kids with only radius pinning, three kids with isolated ulnar fixation, 9 kids with pinning of both bones. Open reposition and fixation with Kirschner wires was done in 13 kids. Results In the group of 22 children with stable fractures results were excellent in 17 (77%), good in 4 (18.5%), and satisfactory in one child (4.5%). In the group of 32 children with unstable fractures excellent results were noted in 24 (75%), good in 4 (12.5%) satisfactory in 3 (9.4%) and unsatisfactory in one child (3.1%) Discussion A large number of forearm fractures in children can be treated with manual reduction and plaster immobilization into a tolerable position. However, in unstable fractures the method of choice is manual reduction with percutaneous pinning. Some authors prefer fixation of both bones, others fix only one. Conclusions Based on our experience it is concluded that orthopedic reposition and percutaneous pinning of unstable forearm fractures in children is very easy to perform, duration of intramedullar fixation is relatively short, removal of pins is also very easy without anesthesia and it requires short period of plaster immobilization. This provides faster rehabilitation and improves quality of life.

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 Analysis of clinicoradiological parameters following fixation of paediatric supracondylar humerus fractures with three lateral pins

2019 ◽  
Vol 5 (2) ◽  
pp. 310
Author(s):  
Saurabh Daga ◽  
Pushpal Sarkar ◽  
Paras Kumar Banka
Keyword(s):  
Percutaneous Pinning ◽  
Kirschner Wires ◽  
Medical College ◽  
Normal Limits ◽  
Fractures In Children ◽  
Ulnar Nerve Palsy ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures ◽  
A Prospective Study ◽  
Pin Configuration

<p class="abstract"><strong>Background:</strong> Supracondylar humerus fractures are one of the commonest fractures encountered in children. This fracture has been managed both conservatively with a long arm plaster and operatively by fixing with Kirschner wires. Debate still remains regarding the pin configuration to be used for fracture stabilisation. This study analyses the clinical and radiological parameters following fixation of supracondylar humerus fractures in paediatric patients with three lateral pins.</p><p class="abstract"><strong>Methods:</strong> It is a prospective study with 30 patients conducted between April 2016 and September 2016 conducted in Medical College and Hospital, Kolkata. All the said patients underwent closed reduction and percutaneous pinning with three laterally placed divergent kirschner wires.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the patients in this study had clinicoradiological parameters well within normal limits, barring a few. The baumann’s angle was well within normal limits in these cases as found in subsequent follow-ups.</p><p class="abstract"><strong>Conclusions:</strong> In this study, it was found that lateral pinning can be safely employed for fixing supracondylar humerus fractures in children with lesser chances of iatrogenic ulnar nerve palsy which was encountered with crossed pin configuration.</p><p> </p>

Management of acute paediatric fractures treated surgically in the UK: a cross-sectional study

2021 ◽  
Author(s):  
MS Rashid ◽  
S Dorman ◽  
S Humphry ◽  
Keyword(s):  
National Standards ◽  
Humeral Fractures ◽  
Orthopaedic Trauma ◽  
Forearm Fractures ◽  
Supracondylar Fractures ◽  
Kirschner Wires ◽  
Radius Fractures ◽  
Supracondylar Humeral Fractures ◽  
Both Bones ◽  
Paediatric Orthopaedic

Introduction The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. Methods Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. Results Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. Conclusion Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.

scholarly journals A 5-year Overview of Forearm Fracture Etiology and Treatment Options in 7-15 Years Old Children

2012 ◽  
Vol 12 (1) ◽  
pp. 36-40
Author(s):  
Janis Upenieks ◽  
Sintija Sloka ◽  
Aigars Petersons ◽  
Anita Villerusa
Keyword(s):  
Closed Reduction ◽  
Bone Fractures ◽  
Pediatric Population ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Forearm Bones ◽  
The Moment ◽  
Wire Osteosynthesis ◽  
Methods Of Treatment ◽  
Plaster Immobilization

SummaryIntroduction.Forearm fractures make up a significant part of overall fracture rate in pediatric population, especially in 7-15 years old children. Different methods of treatment have been used, depending on the age of children and type and localization of fracture. Most controversies can be seen among conservative and surgical methods of treatment.Aim of the Study.The aim of our study is to identify common localizations and types of forearm bone fractures in pediatric population, as well as analyze patient data and treatment process depending on selected method of treatment for out-patients and in-patients.Materials and Methods.Retrospective analysis of out-patient and in-patient records, treated in University Children’s hospital from 2007 to 2011 was made, including first time patients with fractures of one or both forearm bones, according to ICD-10 codes S52.0- S52.9. Demographical data, trauma mechanisms, localization and type of fracture, as well as applied treatment and stay length at hospital were analyzed. 1742 out-patients and 1029 in-patients, 7-15 years old at the moment of trauma, were included in this research.Results.2771 forearm fractures were registered, 62.9% patients were treated on out-patient basis, 37.1 % patients required treatment in hospital. Forearm bone fractures were gender specific - 2235 boys and 536 girls had to be treated (Male:Female ratio was 4.2 : 1). The peak incidence was seen in 13 years old boys and girls. Boys suffered from forearm fractures more often in any age group. Most common mechanisms of injuries causing forearm fractures in children were related with sports trainings - 22.1%, skiing - 15.0% and traffic injuries - 10.0%. Most common activities at the moment of trauma differ by season - during winter months they include skiing, skating and sledging while in summer falls from height, bicycles and swings are dominant. Several trauma mechanisms, like sport trainings, are not season-dependent. Some injury mechanisms differ significantly by gender. Boys were more often as girls injured during sports trainings and skiing, while girls experience forearm fractures due to bicycling and skating. Occurrence of forearm fractures in children has seasonal differences with two peaks: from June to August and from December to February. Distal forearm fractures are the most often seen localization of overall forearm fractures (42 % in boys and 36 % in girls). In out-patients group conservative treatment was performed - plaster immobilization in 1339 cases and closed reduction, followed by plaster immobilization in 403 cases. In-patients were treated both - conservatively with immobilization in 21 cases and closed reduction in 188 cases, and surgically with K-wire osteosynthesis in 137 cases or elastic stable intramedullary nailing (ESIN) in 683 cases. The type and localization of each fracture, along with the age of patient, are the key factors for choosing the right treatment method. K-wire osteosynthesis was performed in all age groups for unstable fractures in distal or proximal third of forearm. ESIN was a method of choice for unstable or comminuted midshaft fractures of one or both bones, metadiaphyseal fractures and some specific conditions (radial neck fractures, Monteggia fractures-dislocations), especially in older patients. Stay length at hospital was ranging from 1 to 2 hospital days in case of immobilization (mean = 1,05 days), from 1 to 4 days in closed reduction group (mean = 1,32 days), but 1 to 12 days in hospital spent children after K-wire osteosynthesis (mean = 1,99 days) or ESIN (mean = 2,38 days).Conclusions.1. Forearm fractures in children have a significant gender diversity (M : F ratio is 4,2 : 1).2. Peak incidence group is 13 years old adolescents of both genders.3. Seasonality and season-specific injury patterns are typical for pediatric forearm fractures.4. The most common anatomic localization is the distal segment of forearm bones.5. Younger children (7-9 years) are mainly treated by conservative methods, while methods of choice for treatment of forearm fractures in adolescents (13-15 years) are operative.6. Surgical treatment of fractures do not significantly increase stay length at hospital.

scholarly journals Pediatric forearm fractures with tens: freedom of movements

2016 ◽  
Vol 2 (3) ◽  
pp. 142
Author(s):  
Shivanna Shivanna ◽  
Maruthi C. V.
Keyword(s):  
Range Of Motion ◽  
Bone Fractures ◽  
Case Series ◽  
Open Fractures ◽  
Forearm Fractures ◽  
Titanium Elastic Nailing ◽  
Fractures In Children ◽  
Elastic Nails ◽  
Both Bones ◽  
Single Bone

<p class="abstract"><strong>Background:</strong> A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented.  </p><p class="abstract"><strong>Methods:</strong> Between 2012 and 2014, 30 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had unstable irreducible fractures, 13 had loss of reduction, and six had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises.<strong></strong></p><p class="abstract"><strong>Results:</strong> Closed reduction and TENS was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months.</p><p class="Default"><strong>Conclusions:</strong> Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results thus achieving maximum range of motion at the earliest.</p>

scholarly journals Prospective Study of Surgical Management of Diaphyseal Fractures of Both Bones Forearm in Older Children Using Titanium Elastic Intramedullary Nailing at a Tertiary Care Hospital in Srikakulam

2021 ◽  
Vol 8 (18) ◽  
pp. 1223-1229
Author(s):  
Dinesh Kumar Tutika ◽  
Vamsi Krishna Kurmana ◽  
Deepak Chamalla ◽  
Shanmukha Rao Gollapalli ◽  
Ranganath Marthala
Keyword(s):  
Prospective Study ◽  
Intramedullary Nailing ◽  
Care Hospital ◽  
Forearm Fractures ◽  
Early Mobilisation ◽  
Older Children ◽  
Titanium Elastic Nailing ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Elastic Intramedullary Nailing

BACKGROUND Diaphyseal fractures of the forearm are one of the common fractures in the paediatric population. Closed reduction and cast immobilisation remain the standard treatment for paediatric diaphyseal forearm fractures owing to their unique remodelling potential. The main concern of conservative management is re-displacement of fracture in cast resulting in the unacceptable angular deformity in the forearm. Intramedullary fixation with titanium elastic nails for paediatric diaphyseal forearm fractures is becoming the trending surgical technique in those cases that warrant surgical intervention. The purpose of this study was to evaluate the functional outcome of the management of fracture of both bones forearm in the older children with titanium elastic nailing system. METHODS This was a prospective study done among thirty patients aged 5 to 16 years admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu, Srikakulam with diaphyseal fractures of both bones forearm from September 2017 to September 2019. We treated the patients by closed / open reduction and internal fixation with elastic stable intramedullary nailing. The patients were followed-up for six months. RESULTS We evaluated the patients clinically and radiologically after surgery. We assessed the outcome using modified Anderson’s AO criteria for forearm fractures extracted from the international journal of current pharmaceutical and clinical research functions. All fractures united at an average of 9.1 weeks without any delayed or non-union. The results were excellent in 86.6 % of patients and good in 13.3 % of patients without significant complications. There were minor complications in 6 patients (20 %). CONCLUSIONS Titanium elastic intramedullary nailing is a safe, effective and minimally invasive surgical method for treatment of displaced both bones forearm diaphyseal fractures in older children. This technique gives relative stability with a three-point fixation principle resulting in secondary bone healing by promoting early callus, ideal for early mobilisation. The technique offers several advantages, including minimal incision, preservation of fracture haematoma, dynamic axial stabilisation, and shorter hospitalisation. KEYWORDS Both Bone Fracture Forearm, Titanium Elastic Nailing System, Early Mobilisation

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