Lieber J, Schmid E, Schmittenbecher P P
University Children's Hospital, Department of Pediatric Surgery, Tübingen, Germany.
Eur J Pediatr Surg. 2010 Nov;20(6):395-8. doi: 10.1055/s-0030-1262843. Epub 2010 Oct 11.
In unstable metaphyseal and diaphyseal forearm fractures the treatment of choice is percutaneous Kirschner wire (K-wire) fixation or elastic stable intramedullary nailing (ESIN), respectively. The optimal treatment for the diametaphyseal transition zone is still a matter of debate.
The diametaphyseal transition zone was defined as the square over the "physis of distal radius and ulna" minus the square of "physis of distal radius alone". Transepiphyseal intramedullary K-wire fixation was performed in unstable fractures affecting this transitional area. The operative, postoperative and functional outcomes were assessed and compared to previously treated patients who were treated using other techniques (plate, external fixator or ESIN).
10 patients received transepiphyseal intramedullary K-wire fixation. Additionally the ulna was stabilized by antegrade ESIN in 5 cases. Cast immobilization was performed for 39, sports restriction for 43 and metal removal was done after 50 days. No complications, bone malalignment, or functional deficits occurred (mean follow-up: 17 months). 13 patients were treated using alternative options. 3 patients had plates with cast immobilization for 26 days, sports restriction for 63 and metal removal after 287 days. 5 patients were treated by external fixation for 54 days. Their sports restriction was 73 days. The remaining 5 patients had ESIN. In 1 of these cases additional cast immobilization was necessary. Their sports restriction was 51 days and metal removal was done after 88 days. In 4 cases a malalignment >10° of the radius was documented, and 1 patient had a functional deficit of forearm pro-/supination.
Transepiphyseal intramedullary K-wire fixation in unstable diametaphyseal forearm fractures is a minimally invasive, quick and technically easy treatment option but requires additional immobilization. Our data suggest that this technique offers advantages compared to alternative treatment options.
在不稳定的干骺端和骨干前臂骨折中，治疗的选择分别是经皮克氏针（K 针）固定或弹性稳定髓内钉（ESIN）。干骺端移行区的最佳治疗方法仍存在争议。
干骺端移行区定义为“桡骨远端和尺骨骨骺”的平方减去“仅桡骨远端骨骺”的平方。对累及该移行区的不稳定骨折进行经骨骺髓内 K 针固定。评估手术、术后和功能结果，并与之前使用其他技术（钢板、外固定器或 ESIN）治疗的患者进行比较。
10 例患者接受了经骨骺髓内 K 针固定。另外，5 例患者的尺骨通过顺行 ESIN 进行了稳定。石膏固定 39 天，限制运动 43 天，50 天后取出金属内固定物。未发生并发症、骨畸形或功能缺陷（平均随访 17 个月）。13 例患者采用了其他治疗方法。3 例患者使用钢板并石膏固定 26 天，限制运动 63 天，287 天后取出金属内固定物。5 例患者接受外固定 54 天。他们限制运动 73 天。其余 5 例患者采用 ESIN。其中 1 例患者需要额外的石膏固定。他们限制运动 51 天，88 天后取出金属内固定物。4 例患者记录到桡骨畸形大于 10°，1 例患者存在前臂旋前/旋后功能缺陷。
不稳定的干骺端前臂骨折采用经骨骺髓内 K 针固定是一种微创、快速且技术上简单的治疗选择，但需要额外的固定。我们的数据表明，与其他治疗选择相比，该技术具有优势。
