Jozsa Gergo, Devecseri Gertrud, Vajda Peter, Juhasz Zsolt, Varga Marcell, Juhasz Tamas
Surgical Division of the Department of Paediatrics, Medical School, University of Pécs.
Medical School, University of Pécs.
Medicine (Baltimore). 2020 Feb;99(7):e17763. doi: 10.1097/MD.0000000000017763.
Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.
桡骨远端干骺端和骨干 - 干骺端不稳定骨折在儿童中可用多种手术技术治疗，如克氏针（K 针）、背侧插入式钛弹性稳定髓内钉（DESIN）和短钛弹性稳定髓内钉（SESIN）。本研究的目的是评估这些方法在临床和影像学结果上的差异。2009年1月至2017年12月期间，196名儿童因桡骨远端三分之一处的前臂骨折接受治疗。研究了患者的性别、不同类型的手术技术、术后X线片数量、取出内固定物的日期以及取出内固定物后的轴线偏移程度。分析了骨折线距桡腕关节面的距离、桡骨远端骨骺的宽度以及尺骨和桡骨远端骨骺的累积宽度。在这196名儿童中，139例通过K针实现骨折稳定，44例通过DESIN实现骨折稳定，13例通过SESIN实现骨折稳定。使用K针固定后，平均取出内固定物的时间明显更短（3.8个月）。在接受K针治疗的儿童中，118例患者的轴向偏移<5°，15例患者的偏移为5°至10°，6例儿童的偏移超过10°。在DESIN组中，37例患者的轴向偏移<5°，7例患者的偏移为5°至10°。在所有接受SESIN治疗的13名儿童中，测得的轴向偏移均<5°。接受K针和DESIN治疗的儿童中，骨折线距桡腕关节面的平均距离分别为23.7和45.6毫米。骨折线距桡腕关节面的距离可能决定所需的手术技术类型。如果骨折线距离小于桡骨远端的宽度，建议使用K针进行骨固定，而如果骨折距离大于桡骨和尺骨的累积宽度，则DESIN可能会提供更好的结果。当生长板区域受伤时，可能需要使用SESIN。
