Schneidmueller D, Kertai M, Bühren V, von Rüden C
Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie der BG Unfallklinik Murnau, Klinikum Garmisch-Partenkirchen, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland.
Krankenhaus Barmherzige Brüder Regensburg - Klinik St. Hedwig, Regensburg, Deutschland.
Unfallchirurg. 2018 Oct;121(10):817-824. doi: 10.1007/s00113-018-0465-z.
Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires.
A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed.
A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique.
In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.
克氏针骨固定术被认为是儿童肱骨髁上骨折和桡骨远端骨折手术固定的标准技术。克氏针可以外露或埋于皮下。皮外技术的优点包括效率高（成本、工作量）以及无需再次麻醉即可取出克氏针。另一方面，人们担心外露的克氏针会导致更高的感染率以及对儿童造成创伤。
对德国骨科与创伤外科学会（DGU）、德国儿童骨科与创伤外科学会（DGOU）、德国儿童矫形外科学会（DGOOC）以及德国骨科与创伤外科学会儿童创伤学组（SKT）的成员进行了一项基于网络的调查，以评估德国目前的治疗理念。记录了每种技术的优缺点，并探讨了开展临床研究的必要性。此外，还对两种方法进行了成本分析。总结并讨论了文献中的结果。
共评估了710份问卷。大多数受访者是在医院工作的创伤外科医生（80%）。在两个骨折组中（肱骨髁上骨折为73%，桡骨远端骨折为69%），埋入技术更具优势，不过根据职业不同可发现存在显著差异。采用皮下技术的主要原因是担心皮外技术感染率较高或观察到感染率较高。
在德国，由于担心感染率较高，大多数克氏针被埋于皮下。此外，疼痛和传统方法等其他影响因素也起着重要作用。鉴于文献中的结果以及可能提高效率和避免再次麻醉，未来似乎有必要开展一项多中心临床研究来比较这两种技术。
