Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):489-497. doi: 10.1007/s00590-023-03686-9. Epub 2023 Aug 26.
The modified Kapandji technique has been proposed for fracture reduction in pediatric displaced distal radius fractures (DDRFs), but evidence is sparse. The purpose of this study was to evaluate our outcomes and complications, critically and systematically, when performing the modified Kapandji technique in pediatric DDRFs. Using this technique since 2011, we asked: (1) What is the quality of fracture reduction using this technique? (2) How stable is fracture alignment with this technique? (3) What are the postoperative complications and complication rates?
Retrospective observational study of 195 pediatric patients treated with the modified Kapandji technique. Quality of fracture reduction, fixation type (intrafocal, combined, or extrafocal), and coronal/sagittal angulation were recorded at surgery and healing. Perioperative complications were graded. Patients were stratified by fracture (metaphyseal or Salter-Harris) and fixation type, as well as age (≤ 6 years; 6 to 10 years; > 10 years).
Fracture reduction was 'good' to 'anatomical' in 85% of patients. 'Anatomical' fracture reduction was less frequent in metaphyseal fractures (21% vs. 51%; p < .001). Mean angulation change was higher in metaphyseal fractures in both the sagittal (p = .011) and coronal (p = .021) planes. Metaphyseal fractures showed a higher mean change in sagittal angulation during fracture healing for the 'intrafocal' group. We observed a 15% overall complication rate with 1% being modified Sink Grade 3.
The modified Kapandji technique for pediatric DDRFs is a safe and effective treatment option. Metaphyseal fractures that do not involve the physis should be treated with extrafocal or combined wire fixation. Complications that require additional surgical treatment are rare.
Level of evidence IV.
改良 Kapandji 技术已被提出用于治疗儿童移位性桡骨远端骨折（DDRF），但证据有限。本研究旨在对我们使用改良 Kapandji 技术治疗儿童 DDRF 的结果和并发症进行批判性和系统性评估。自 2011 年以来，我们一直使用该技术，因此提出以下问题：（1）使用该技术的骨折复位质量如何？（2）该技术下骨折对线稳定性如何？（3）术后并发症及并发症发生率是多少？
回顾性观察研究 195 例采用改良 Kapandji 技术治疗的儿童患者。记录手术和愈合时的骨折复位质量、固定类型（病灶内、联合或病灶外）和冠状/矢状成角。分级记录围手术期并发症。根据骨折（干骺端或 Salter-Harris）和固定类型以及年龄（≤6 岁；6-10 岁；>10 岁）对患者进行分层。
85%的患者骨折复位为“良好”至“解剖复位”。干骺端骨折的“解剖复位”比例较低（21% vs. 51%；p<0.001）。在冠状面和矢状面，干骺端骨折的平均成角变化均较高（p=0.011 和 p=0.021）。在病灶内固定组，干骺端骨折在骨折愈合过程中矢状成角的平均变化更大。我们观察到总体并发症发生率为 15%，其中改良 Sink 分级 3 级占 1%。
改良 Kapandji 技术治疗儿童 DDRF 是一种安全有效的治疗方法。不涉及骨骺的干骺端骨折应采用病灶外或联合钢丝固定。需要进一步手术治疗的并发症罕见。
IV 级。
