Teoh Kar Hao, Chee Yu-Han, Shortt Nicholas, Wilkinson Graham, Porter Daniel E
Department of Orthopaedic Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK,
J Child Orthop. 2009 Oct;3(5):367-73. doi: 10.1007/s11832-009-0197-2. Epub 2009 Aug 23.
Intramedullary (IM) nailing and plating are recognised fixation methods for both-bone midshaft forearm fractures. Although both methods are effective, IM nailing has recently been the accepted operative treatment for the paediatric population. The aim of the study was to compare the differences in the radiographic and functional outcomes of an age- and sex-matched cohort of children following treatment by IM fixation or plate fixation with screws for an unstable both-bone diaphyseal fracture.
A retrospective study was conducted and 17 age- and sex-matched pairs of patients returned for a research review clinic. The average age of our patients was 11.6 years at follow up, with 11 boys and six girls in each group. The mean follow up was similar in both groups (IM 31.5 months, plating 31.8 months).
Plating and IM nailing result in good or excellent functional and radiological outcomes. Radiographs at the review clinic showed complete healing in the plating group, with reconstitution of the radial bow. Three patients in the IM group did not regain the natural radial bow radiographically. There were no significant differences between both groups for maximum radial bow and its location (P > 0.05). However, the maximum radial bow was significantly different from normative values in both groups (P = 0.003 plate, P = 0.005 IM). No non-union or malunion was observed. There were no significant differences in the loss of forearm motion and grip strength between both groups. There was no difference in the Pediatric Orthopaedic Society of North America (POSNA) scores between both groups. The plating group had a significantly worse Manchester scar score than the IM group (P = 0.012). One major complication was observed in each group: osteomyelitis for IM fixation and ulnar never palsy for plating.
Our study suggests that functional outcome is likely to be equivalent, regardless of which method of internal fixation is used.
髓内钉固定和钢板固定是公认的双骨干前臂中段骨折的固定方法。虽然这两种方法都有效，但髓内钉固定最近已成为小儿患者公认的手术治疗方法。本研究的目的是比较年龄和性别匹配的儿童队列在采用髓内固定或钢板螺钉固定治疗不稳定双骨干骨折后的影像学和功能结果差异。
进行了一项回顾性研究，17对年龄和性别匹配的患者返回研究复查门诊。随访时患者的平均年龄为11.6岁，每组有11名男孩和6名女孩。两组的平均随访时间相似（髓内钉固定组31.5个月，钢板固定组31.8个月）。
钢板固定和髓内钉固定均产生良好或优异的功能和影像学结果。复查门诊的X线片显示钢板固定组完全愈合，桡骨弓形恢复。髓内钉固定组有3例患者在影像学上未恢复自然桡骨弓形。两组之间最大桡骨弓形及其位置无显著差异（P>0.05）。然而，两组的最大桡骨弓形均与正常值有显著差异（钢板固定组P = 0.003，髓内钉固定组P = 0.005）。未观察到骨不连或畸形愈合。两组之间前臂活动度和握力丧失无显著差异。两组之间北美小儿骨科学会（POSNA）评分无差异。钢板固定组的曼彻斯特瘢痕评分明显低于髓内钉固定组（P = 0.012）。每组均观察到1例主要并发症：髓内固定组为骨髓炎，钢板固定组为尺神经麻痹。
我们的研究表明，无论采用哪种内固定方法，功能结果可能相当。
