Scharf Markus, Walter Nike, Rupp Markus, Alt Volker
Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
Department for Psychosomatic Medicine, University Hospital Regensburg, 93053 Regensburg, Germany.
Children (Basel). 2023 Mar 18;10(3):581. doi: 10.3390/children10030581.
Closed reduction and K-wire fixation of displaced distal radius fractures in children and adolescents is an established and successful surgical procedure. Fracture-related infections after K-wire fixation are rare but can have significant consequences for the patient. There is a lack of literature on the treatment of K-wire-associated fracture-related infections in children and adolescents. Herein, we report two cases of fracture-related infection after initial closed reduction and Kirschner wire fixation in two adolescents. One 13-year-old boy and one 11-year-old girl were seen for fracture-related infections 4 and 8 weeks after closed reduction and percutaneous K-wire fixation of a distal radius, respectively. X-ray and magnetic resonance imaging (MRI) revealed a healed fracture with osteolytic changes in the metaphyseal radius with periosteal reaction and abscess formation of the surrounding soft tissue structures. A two-staged procedure was performed with adequate debridement of the bone and dead space management with an antibiotic-loaded polymethyl methacrylate (PMMA) spacer at stage 1. After infection control, the spacer was removed and the defect was filled with autologous bone in one case and with a calcium sulphate-hydroxyapatite biomaterial in the other case. In each of the two patients, the infection was controlled and a stable consolidation of the distal radius in good alignment was achieved. In one case, the epiphyseal plate was impaired by the infection and premature closure of the epiphyseal plate was noted resulting in a post-infection ulna plus variant. In conclusion, a fracture-related infection after Kirschner wire fixation of pediatric distal radius fractures is a rare complication but can occur. A two-stage procedure with infection control and subsequent bone defect reconstruction was successful in the presented two cases. Premature closure of the epiphyseal growth plate of the distal radius is a potential complication.
儿童和青少年桡骨远端移位骨折的闭合复位及克氏针固定是一种成熟且成功的外科手术。克氏针固定后与骨折相关的感染虽罕见，但可能给患者带来严重后果。目前缺乏关于儿童和青少年克氏针相关骨折感染治疗的文献。在此，我们报告两例青少年在初次闭合复位及克氏针固定后发生的与骨折相关的感染病例。一名13岁男孩和一名11岁女孩分别在桡骨远端闭合复位及经皮克氏针固定后4周和8周因骨折相关感染前来就诊。X线和磁共振成像（MRI）显示骨折已愈合，干骺端桡骨有溶骨改变，伴有骨膜反应及周围软组织结构脓肿形成。在第一阶段进行了两期手术，对骨进行了充分清创并采用含抗生素的聚甲基丙烯酸甲酯（PMMA）间隔物进行死腔处理。感染得到控制后，在一例中取出间隔物，用自体骨填充缺损，另一例则用硫酸钙 - 羟基磷灰石生物材料填充。两名患者的感染均得到控制，桡骨远端均实现了良好对线的稳定愈合。在一例中，感染累及骨骺板，发现骨骺板过早闭合，导致感染后尺骨正向变异。总之，儿童桡骨远端骨折克氏针固定后与骨折相关的感染是一种罕见的并发症，但可能发生。在本报告的两例病例中，采用控制感染及随后进行骨缺损重建的两期手术取得了成功。桡骨远端骨骺生长板过早闭合是一种潜在并发症。
