Orthopedic Department, Assiut University Hospital, Assiut.
Orthopedic Department, South Valley University, Qena, Egypt.
J Pediatr Orthop. 2023;43(10):e783-e789. doi: 10.1097/BPO.0000000000002516. Epub 2023 Sep 7.
The primary objective was to compare the re-fracture incidence of both radius and ulna fracture in 2 groups treated using intramedullary Kirschner wires (K-wires) where the wires were exposed in group I and buried in group II. The secondary objective was to compare the final functional outcomes and complications incidence.
Between March 2019 and February 2021, 60 pediatric patients with unstable radius and ulna fractures amenable to surgical intervention using intramedullary K-wires were randomized into group I (K-wires were exposed above the skin by 2 cm) or group II (K-wires were buried under the skin). In group I, K-wires were removed in the outpatient clinic, while in group II, they were removed under general anesthesia as a day-case procedure. Functional outcome per Price criteria was reported at 1-year follow-up.
Included patients had a mean age of 7.6 years (range: 5 to 10 y). The mean operative time was significantly higher in group II (32.33±7.51 vs. 36.77±8.70 min, P =0.03), with no difference regarding intraoperative x-ray exposure (43.12±15.52 vs. 41.6±11.96 s, P =0.67). Fracture union was achieved after a mean of 44±2.6 days in group I and 43±1.87 days in group II, with no difference between both groups ( P =0.34). One patient had re-fracture in group I and no patients in group II; however, the difference was insignificant ( P =0.12). Infection occurred in 2 patients in each group. All patients reported excellent scores per Price criteria and achieved full wrist and elbow range of motion compared with the contralateral noninjured side.
Exposed implants are a safe option when dealing with forearm fractures in patients younger than 11 years old, with the added advantage of fewer hospital admissions. Furthermore, it had a similar complication rate and functional outcomes compared with buried implants.
ClinicalTrials.gov, NCT03906929.
Level II.
主要目的是比较两组使用髓内克氏针（K 线）治疗的桡骨和尺骨骨折的再骨折发生率，其中一组 K 线外露，另一组 K 线埋入。次要目的是比较最终功能结果和并发症发生率。
2019 年 3 月至 2021 年 2 月，60 例儿童不稳定桡骨和尺骨骨折患者适合采用髓内 K 线治疗，随机分为 I 组（K 线在皮肤上方外露 2cm）或 II 组（K 线埋在皮肤下）。I 组在门诊取出 K 线，II 组在全身麻醉下作为日间手术取出。1 年后根据 Price 标准报告功能结果。
纳入患者的平均年龄为 7.6 岁（5 至 10 岁）。II 组的平均手术时间明显较长（32.33±7.51 比 36.77±8.70 分钟，P =0.03），但术中 X 线暴露时间无差异（43.12±15.52 比 41.6±11.96 秒，P =0.67）。I 组骨折愈合时间平均为 44±2.6 天，II 组为 43±1.87 天，两组间无差异（P =0.34）。I 组有 1 例再骨折，II 组无再骨折，但差异无统计学意义（P =0.12）。两组各有 2 例发生感染。所有患者均根据 Price 标准报告了优秀评分，并与对侧未受伤侧相比，实现了完全的腕关节和肘关节活动范围。
对于 11 岁以下的前臂骨折患者，暴露的植入物是一种安全的选择，并且可以减少住院次数。此外，与埋植植入物相比，它具有相似的并发症发生率和功能结果。
ClinicalTrials.gov，NCT03906929。
II 级。
