ANTEGRADE ELASTIC STABABLE INTRAMEDULARI NAILING IN TREATMENT OF DISTAL RADIUS DIAPHYSEAL METAPHYSEAL JUNCTION FRACTURES IN CHILDREN

Authors

  • Lazar Todorovikj University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Zlatko Aleksovski University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
  • Marjan Kamiloski University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Natalija Cokleska Shuntov University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Anila Racaj University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
  • Sanja Gjorikj University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
  • Shaban Memeti University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Sandra Petkovska Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Keywords:

ESIN, pediatric, distal radius diaphyseal metaphyseal junction fracture.

Abstract

The fractures of distal radius diaphyseal metaphyseal junction (DRDMJ) are one of the most frequent fractures in the pediatric population. In most cases, treatment of the fractures of DRDMJ is conservative. The aim of this study was to evaluate the benefits of using a new minimally invasive approach of closed reduction and internal fixation using an antegrade surgical approach and elastic stable intramedullary nail in the treatment of distal radius diaphyseal metaphyseal junction fractures in the pediatric population and to analyze the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation. This study included 30 cases treated in the period from 2019 to 2021, where the use of non-surgical treatment did not work in children with distal radius diaphyseal metaphyseal junction fractures. In the surgical treatment, we used one titanium nail (2 or 2.5 mm) to achieve a correct closed reduction and internal fixation. The fracture healing was achieved in about 6 to 12 weeks after the procedure. Patients were then followed for another 6 months. In the postoperative period, there was no significant loss of reduction and no secondary displacement, nail migration, loss of fixation, non-union, or refracture. The combination of the closed reduction technique and the antegrade ESIN fixation is commonly used for the treatment of completely dislocated fractures in children. With this method we achieved minimally invasive treatment, short immobilization period, growth plate was not involved in the treatment and good outcome was accomplished.

References

Randsborg PH, Gulbrandsen P, Saltyte Benth J, Sivertsen EA, Hammer OL, Fuglesang HF, et al. Fractures in children: epidemiology and activity-specific fracture rates. J Bone Joint Surg Am 2013; 95(7): e421-e427. doi: 10.2106/JBJS.L.00369.

Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg. 2014; 99(3): 269-275. https://doi.org/10.9738/ INTSURG-D-13-00065.1.

Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop 2005; 25(4): 490-494. Available from: https://doi.org/ 10.1097/01.bpo.0000158780.52849.39.

Huang W, Zhang X, Zhu H, Wang X, Sun J, Shao X. A percutaneous reduction technique for irreducible and difficult variant of paediatric distal radius and ulna fractures. Injury 2016; 47(6): 1229-1235. Available from: https://doi.org/ 10.1016/ j.injury.2016.02.011.

Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg 2010; 20(6): 395-398. doi: 10.1055/s-0030-1262843.

Johari AN, Sinha M. Remodeling of forearm fractures in children. J Pediatr Orthop B 1999; 8(2): 84-87. https://doi.org/10.1097/00009957-199904000-00003.

Roberts JA. Angulation of the radius in children's fractures. J Bone Joint Surg Br 1986; 68(5): 751-754. doi:10.1302/0301-620X.68B5.3782237.

Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 1981; 63(6): 872-877. PMID: 7240327.

Asadollahi S, Pourali M, Heidari K. Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices. Acta Orthop 2017; 88(1): 101-108. doi: 10.1080/17453674.2016.1255784.

Bowman EN, Mehlman CT, Lindsell CJ, Tamai J. Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure. J Pediatr Orthop 2011; 31(1): 23-32. doi: 10.1097/BPO.0b013e318203205b.

Pace JL. Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations. J Am Acad Orthop Surg 2016; 24(11): 780-788. doi: 10.5435/JAAOS-D-15-00151.

Lobo-Escolar A, Roche A, Bregante J, Gil-Alvaroba J, Sola A, Herrera A. Delayed union in pediatric forearm fractures. J Pediatr Orthop 2012; 32(1): 54-57. doi: 10.1097/BPO.0b013e31823832ea.

Ozturk A, Kutlu C, Taskara N, Kale AC, Bayraktar B, Cecen A. Anatomic and morphometric study of the arcade of Frohse in cadavers. Surg Radiol Anat 2005; 27(3): 171-175. doi: 10.1007/s00276-005-0321-z.

Zheng W, Tao Z, Chen C, Zhang C, Zhang H, Feng Z, et al. Comparison of three surgical fixation methods for dual-bone forearm fractures in older children: A retrospective cohort study. Int J Surg 2018; 51: 10-16. doi: 10.1016/j.ijsu.2018.01.005.

Downloads

Published

2023-06-16 — Updated on 2023-07-06

Versions

Issue

Vol. 3 No. 2 (2023): Acad Med J

Section

Surgical techniques