Cintean Raffael, Eickhoff Alexander, Pankratz Carlos, Strauss Beatrice, Gebhard Florian, Schütze Konrad
Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
J Clin Med. 2022 Jul 31;11(15):4478. doi: 10.3390/jcm11154478.
Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains.
A total of 237 patients (mean age 8.3 ± 3.4 (1-16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed.
In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%).
Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.
前臂骨折是儿童最常见的骨折之一。在过去几年中，出现了手术治疗的趋势，尤其是闭合复位及弹性稳定髓内钉内固定术（ESIN）。尽管总体并发症发生率较低，但术中仍存在并发症风险。
本研究纳入了2010年至2020年间采用ESIN治疗的237例前臂或桡骨骨折患者（平均年龄8.3±3.4（1 - 16）岁）。对245例患者进行回顾性分析，重点关注骨折类型、术前和术后骨折成角、术中和术后并发症以及髓内钉植入的手术入路。通过影像学测量骨折类型及术前和术后成角情况。进一步分析诸如拇长伸肌（EPL）肌腱断裂和桡浅神经感觉障碍等并发症。
201例（82%）采用了背侧入路；44例骨折（17.9%）采用了桡侧入路。总共发现25例（10%）与手术相关的并发症，其中21例（8.6%）需要进一步手术治疗。共有14例EPL肌腱断裂（5.7%）、4例桡浅神经感觉障碍（1.6%）、2例取出植入物后再骨折（0.8%）、2例表浅伤口感染（0.8%）以及1例术后活动范围受限的患儿（0.4%）。未观察到术前和术后成角与骨折类型或弹性髓内钉直径之间存在统计学意义。正如预期的那样，术后成角有显著改善。与背侧入路（8.5%）相比，在桡骨远端骨折中采用桡侧入路显示手术相关并发症发生率较低，其中2.3%也需要进一步手术治疗，且术后成角情况更好。
特别是由于损伤EPL肌腱的风险较低，桡侧入路显示出需要进一步手术治疗的并发症发生率较低。桡浅神经损伤的风险仍然存在。
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