Department of Pediatric Surgery and Orthopaedics, University Hospital of Oulu; PEDEGO Research Unit and Medical Research Centre, Oulu University, Finland.
Department of Surgery and Orthopaedics, University Hospital of Lausanne, Switzerland.
Injury. 2020 Apr;51(4):856-862. doi: 10.1016/j.injury.2020.03.028. Epub 2020 Mar 10.
The gold-standard surgical procedure of both-bone forearm shaft fracture repair is elastic stable intramedullary nailing (ESIN). Disadvantages effects of ESIN have suggested to be a consequence of inappropriate surgical techniques, while recommendations are not always followed. The purpose of the study was to analyze the effect of inadequate metal frame construct on impaired fracture healing, refracture and changing alignment.
It is a population-based study including all consecutive patients, aged less than 16 years, who had been treated for forearm shaft fracture by ESIN during the ten-year period 2009-2018. Altogether 71 patients were included. Non-union, delayed union, and re-fracture during the following 12 months were taken as the main outcome, while inferior metal frame construct of ESIN and the surgical technique characteristics were taken the explanatory factors. Radiographic loss of reduction was a secondary outcome and a change >5° in alignment at any postoperative follow-up exam was recognized.
Two out of 71 fractures (3%) failed to unite, and ossifying operation was needed. Five cases (7%) showed delayed bone healing, but they ossified in five months without any intervention. These seven patients (10%) had been treated more often with larger nails (> 0.7x MCD) (p = 0.027) and by open reduction (p = 0.02), compared with thinner nails and closed reduction, respectively. Two (3%) patients had a second fracture; however, they happened 2 years after the initial injury. Other surgery or fracture related factors didn't associate with impaired ossifying. Regarding the secondary outcome, altogether 24 (35%) of the analyzed 67 patients showed >5° change in alignment during the postoperative follow-up but only one patient had clinically significant instability that required re-reduction. The alignment changed more usually in distal-third fractures, compared with middle or proximal third fractures (p = 0.019).
ESIN resulted in good radiographic bone healing in the vast majority (90%) of the patients and completely perfect metal frame construct was not required.
双骨前臂骨干骨折修复的金标准手术是弹性稳定髓内钉（ESIN）。ESIN 的一些不良影响被认为是手术技术不当的结果，尽管已经提出了一些建议，但这些建议并不总是被遵循。本研究的目的是分析不适当的金属框架结构对骨折愈合不良、再骨折和改变对线的影响。
这是一项基于人群的研究，纳入了 2009 年至 2018 年期间接受 ESIN 治疗的所有年龄小于 16 岁的连续前臂骨干骨折患者。共纳入 71 例患者。非愈合、延迟愈合和 12 个月内再骨折被视为主要结果，而 ESIN 的较差金属框架结构和手术技术特征被视为解释因素。放射学复位丢失是次要结果，任何术后随访检查中对线的变化>5°被认为是对线改变。
71 例骨折中有 2 例（3%）未愈合，需要进行骨化手术。5 例（7%）出现骨愈合延迟，但在没有任何干预的情况下，在 5 个月内骨化。这 7 例（10%）患者的治疗中更常使用较大的钉子（>0.7x MCD）（p=0.027）和切开复位（p=0.02），而分别使用较细的钉子和闭合复位。2 例（3%）患者发生第二次骨折；然而，它们发生在初次损伤后 2 年。其他手术或骨折相关因素与骨愈合不良无关。关于次要结果，在 67 例分析的患者中，共有 24 例（35%）在术后随访期间出现>5°的对线变化，但只有 1 例患者出现临床显著不稳定，需要重新复位。远端三分之一骨折的对线变化更为常见，与中三分之一或近三分之一骨折相比（p=0.019）。
ESIN 使绝大多数（90%）患者的影像学骨愈合良好，并不需要完全完美的金属框架结构。
