Department of Orthopedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York, NY.
Department of Orthopedic Surgery, Texas Tech, El Paso, TX.
Tech Hand Up Extrem Surg. 2023 Sep 1;27(3):161-164. doi: 10.1097/BTH.0000000000000430.
Fractures involving the distal radius metaphyseal-diaphyseal junction (MDJ) present a unique challenge for pediatric orthopedic surgeons. These fractures are too proximal for percutaneous K -wire fixation and too distal for retrograde flexible nailing. The purpose of this study was to: (1) determine the safety of a described antegrade approach from the posterior interosseous nerve (PIN); (2) assess the efficacy of antegrade nailing in cases of distal MDJ fractures; and (3) describe a standardized lateral approach to the proximal radius. A cadaveric study was performed using 10 adult forearms. Anterograde flexinail was introduced at the proximal radius based on the described "safe zone". Distal MDJ fractures were created using osteotomes. We evaluated the distance between the entry point to the PIN in addition to the quality of the reduction for the fracture. The average distance between the entry point and piercing instrument to the PIN was 5.4 cm (range: 4.7 to 6.0 cm). When grouped based on sex, the average distance was significantly further for males (5.8 cm, range: 5.2 to 6.0 cm) versus females (4.9 cm, range: 4.7 to 5.2 cm), P =0.004. Fracture reduction was not maintained after the introduction of the antegrade flexible nail across the fracture site. For all specimens, >25% displacement was seen on the anterior-posterior imaging. Our modified lateral approach to the starting point in the proximal radius is safe as long as the entry point for antegrade flexible nailing stays proximal to the radial tuberosity during the lateral approach to the proximal radius while the elbow is flexed and the forearm pronated.
涉及桡骨远端干骺端-骨干交界处（MDJ）的骨折对小儿矫形外科医生来说是一个独特的挑战。这些骨折对于经皮 K 线固定来说太靠近近端，对于逆行弹性钉固定来说又太靠近远端。本研究的目的是：（1）确定从骨间后神经（PIN）后方描述的前路入路的安全性；（2）评估前路钉固定治疗远端 MDJ 骨折的疗效；（3）描述一种标准化的桡骨近端外侧入路。对 10 个成人前臂进行了尸体研究。根据描述的“安全区”，在桡骨近端引入顺行 Flexinail。使用骨凿创建远端 MDJ 骨折。我们评估了进入 PIN 的入点与 PIN 之间的距离，以及骨折的复位质量。进入点与穿入器械到 PIN 的平均距离为 5.4cm（范围：4.7 至 6.0cm）。根据性别分组时，男性（5.8cm，范围：5.2 至 6.0cm）的平均距离明显大于女性（4.9cm，范围：4.7 至 5.2cm），P=0.004。在前路弹性钉穿过骨折部位后，骨折复位无法维持。对于所有标本，在前后成像上都看到了>25%的移位。只要在将桡骨近端的经皮 Flexinail 引入近端时，桡骨近端的起始点的外侧入路的进入点保持在桡骨粗隆近端，并且肘部弯曲和前臂旋前，我们改良的桡骨近端起始点的外侧入路是安全的。
