Celebi Levent, Muratli Hasan Hilmi, Doğan Ozgür, Yağmurlu Mehmet Firat, Akşahin Ertuğrul, Biçimoğlu Ali
Ankara Numune Eğitim ve Araştirma Hastanesi 3. Ortopedi ve Travmatoloji Kliniği.
Acta Orthop Traumatol Turc. 2007;41(3):175-82.
We assessed the results of intramedullary nailing in children who developed redisplacement during cast treatment of both-bone forearm fractures.
Twenty-eight children (19 boys, 9 girls; mean age 10.6 years; range 8 to 15 years) were treated with intramedullary fixation upon failure of initial reduction of both-bone forearm fractures after a mean of four weeks (range 3 to 6 weeks) of cast treatment. Intramedullary fixation was performed following closed (n=20) or open (n=8) reduction using K-wires in the first 10 cases, and titanium elastic nails in 18 cases. Single bone fixation was possible in four (14.3%) cases. For malunion assessment, the amount and location of the maximum radial bow were measured and compared with the normal side and with corresponding extremities of age-matched controls. Functional results were assessed using the Grace-Eversmann criteria. The mean follow-up was 14 months (range 12 to 18 months).
Except for a nonunion of the ulna in one patient who underwent single bone fixation, all correction losses could be restored to normal alignment and united within a mean of seven weeks (range 6 to 8 weeks). The amount and location of the maximum radial bow did not differ significantly from those of the normal side and control extremities (p>0.05). Functional results were excellent in 25 patients (89.3%), good in two patients (7.1%), and unacceptable in one patient (3.6%). None of the patients developed infection, neurapraxia, or after removal of the nail, angulation, refracture, or extremity length discrepancy.
Intramedullary fixation for correction losses during cast treatment of both-bone forearm fractures is a safe and inexpensive treatment, allowing early mobilization and providing excellent anatomic and functional results.
我们评估了在双骨干前臂骨折石膏治疗期间发生再移位的儿童中髓内钉固定的效果。
28名儿童（19名男孩，9名女孩；平均年龄10.6岁；范围8至15岁）在平均四周（范围3至6周）的石膏治疗后双骨干前臂骨折初始复位失败，接受了髓内固定治疗。前10例采用克氏针进行闭合（n = 20）或开放（n = 8）复位后进行髓内固定，18例采用钛弹性髓内钉。4例（14.3%）可行单骨固定。对于畸形愈合评估，测量最大桡骨弓的量和位置，并与正常侧以及年龄匹配对照的相应肢体进行比较。使用Grace-Eversmann标准评估功能结果。平均随访14个月（范围12至18个月）。
除1例接受单骨固定的患者尺骨不愈合外，所有矫正丢失均恢复至正常对线并在平均7周（范围6至8周）内愈合。最大桡骨弓的量和位置与正常侧和对照肢体相比无显著差异（p>0.05）。25例患者（89.3%）功能结果优秀，2例患者（7.1%）良好，1例患者（3.6%）不可接受。所有患者均未发生感染、神经失用，取出髓内钉后也未出现成角、再骨折或肢体长度差异。
双骨干前臂骨折石膏治疗期间矫正丢失的髓内固定是一种安全且经济的治疗方法，可早期活动并提供优异的解剖和功能结果。
