Du Mengmeng, Han Jiuhui
Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Injury. 2019 Feb;50(2):598-601. doi: 10.1016/j.injury.2019.01.001. Epub 2019 Jan 6.
The treatment of paediatric distal radius diaphyseal metaphyseal junction (DRDMJ) fractures is a challenge. The purpose of this study was to introduce a new operative approach at the proximal "safe zone" of the posterior interosseous nerve (PIN) to treat paediatric DRDMJ fractures and analyse the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation.
Thirty paediatric patients with unstable and displaced DRDMJ fractures were treated by antegrade ESIN fixation from November 2015 to September 2017. We created the entrance site at the posterolateral side of the proximal radius and 2˜4 cm distal to the articular surface of the radius, using the ESIN to immobilise the fractures. In the study, we reviewed patient demographics, complications, time until removal, and intraoperative time for hardware removal.
Complete fracture healing was achieved between 6 and 12 weeks after surgery. Except for 3 patients presenting with irritation of the skin, we did not observe any complications. Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, non-union, or refracture was noted.
The antegrade ESIN fixation is a minimally invasive, easy-to-learn, alternative operative method to treat paediatric DRDMJ fractures.
Therapeutic Level IV.
小儿桡骨远端骨干骺端交界区（DRDMJ）骨折的治疗具有挑战性。本研究的目的是介绍一种经骨间后神经（PIN）近端“安全区”的新型手术入路，用于治疗小儿DRDMJ骨折，并分析顺行弹性稳定髓内钉（ESIN）固定的安全性和有效性。
2015年11月至2017年9月，对30例不稳定及移位的小儿DRDMJ骨折患者采用顺行ESIN固定治疗。在桡骨近端后外侧、桡骨关节面远端2～4 cm处制作入钉点，使用ESIN固定骨折。本研究回顾了患者的人口统计学资料、并发症、取出内固定物的时间及术中取出内固定物的时间。
术后6～12周骨折完全愈合。除3例出现皮肤刺激外，未观察到任何并发症。影像学检查未发现继发移位、髓内钉移位、内固定失效、骨痂延迟、骨不连或再骨折。
顺行ESIN固定是一种微创、易于学习的治疗小儿DRDMJ骨折的替代手术方法。
治疗性四级。
