Antabak Anko, Luetic Tomislav, Ivo Sjekavica, Karlo Robert, Cavar Stanko, Bogovic Marko, Medacic Suzana Srsen
Division of Surgery, Department of Paediatric Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
Injury. 2013 Sep;44 Suppl 3:S11-5. doi: 10.1016/S0020-1383(13)70190-6.
Elastic-stable intramedullary nailing (ESIN), is an accepted method for stabilization of unstable forearm shaft fractures in children. This study analyzed the radiographic and functional outcomes of intramedullary nailing of forearm diaphyseal fractures in children.
A retrospective analysis was performed of children with forearm shaft fractures and open epiphyseal plates, treated with ESIN between 2000 and 2012 in our institution. Evaluation of cases was conducted minimum 14 months after osteosynthesis. Clinical results were evaluated according to the criteria developed by Price et al. and Flynn et al.
The study included 88 (42 boys) children. The average age of children at day injury was 10.5 ± 2.59 years (range 4-16), and at the review clinic was 13.4 ± 1.85 years (range 7-18). Forty six (52.3 %) had right forearm and 42 (47.7%) had left fracture respectively. Open reduction was required in 20 (22.7%) children. Primarily surgically were treated 62 (70.5%) children and 26 (29.5%) were operated as a second procedure after failed conservative management. There was one delayed union. Rotational forearm restriction with values between 11 and 20 degrees was present in nine children. Six children developed radial nerve hypoesthesia which eventually resolved with time. After removal of the implant one child sustained a re-fracture. The overall complication rate was 25%. Complete recovery to the original condition was noted in 76 (86.4%) children, eleven children (12.5%) had good and only one (1.1%) had poor outcome.
Our study suggests that ESIN osteosynthesis for diaphyseal forearm fractures remains a valid technique with very good functional results.
弹性稳定髓内钉固定术（ESIN）是治疗儿童不稳定型前臂骨干骨折的一种公认方法。本研究分析了儿童前臂骨干骨折髓内钉固定的影像学和功能结果。
对2000年至2012年在我院接受ESIN治疗的前臂骨干骨折且骨骺板开放的儿童进行回顾性分析。在骨合成后至少14个月对病例进行评估。根据Price等人和Flynn等人制定的标准评估临床结果。
该研究纳入了88名儿童（42名男孩）。受伤当天儿童的平均年龄为10.5±2.59岁（范围4 - 16岁），复查时的平均年龄为13.4±1.85岁（范围7 - 18岁）。分别有46名（52.3%）儿童右侧前臂骨折，42名（47.7%）儿童左侧骨折。20名（22.7%）儿童需要切开复位。62名（70.5%）儿童接受了一期手术治疗，26名（29.5%）儿童在保守治疗失败后作为二期手术接受治疗。出现1例骨延迟愈合。9名儿童存在11至20度之间的前臂旋转受限。6名儿童出现桡神经感觉减退，最终随时间逐渐恢复。取出内固定物后，1名儿童再次骨折。总体并发症发生率为25%。76名（86.4%）儿童完全恢复到原来的状态，11名儿童（12.5%）恢复良好，只有1名（1.1%）儿童预后较差。
我们的研究表明，ESIN用于前臂骨干骨折的骨合成仍然是一种有效的技术，功能结果非常好。
