Dietzel Markus, Scherer Simon, Spogis Jakob, Kirschner Hans Joachim, Fuchs Jörg, Lieber Justus
Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 3, D-72076, Tübingen, Germany.
Department of Diagnostic Radiology, University Hospital, Hoppe-Seyler-Strasse 3, D-72076, Tübingen, Germany.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):2681-2687. doi: 10.1007/s00068-024-02562-3. Epub 2024 May 31.
Treatment of unstable forearm fractures in the metaphyseal-diaphyseal junction (MDJ) zone is still a matter of debate. Major drawbacks of all types of fixations include either invasiveness, technical impracticality, or lack of acceptance by patients. This study reports results after antegrade ESIN (a-ESIN) compared to transepiphyseal intramedullary K-wire (TIK) for unstable MDJ forearm fractures.
The MDJ of the forearm was defined as the square over the joints of both forearm bones subtracted with the square over the metaphysis of the radius alone. The data of 40 consecutive patients < 16 years of age who were treated either by a-ESIN (later treatment period) or TIK (early treatment period) for an unstable MDJ forearm fracture at a single high-volume pediatric trauma center were retrospectively analyzed.
The average age was slightly lower in the first group (TIK = 7.42 years; a-ESIN = 10.5 years). An additional ulna fracture was found in 50% of cases and was treated with a classic antegrade ESIN in 10/20 (TIK) and 6/20 cases (a-ESIN). Additional plaster cast immobilization was performed in all cases with TIK and in three cases with a-ESIN. After TIK, no complication, malalignment, or functional limitation occurred. After a-ESIN, 19/20 patients had an event-free course with stable retention and healing without axial malalignment. In one case, a temporary sensor dysfunction occurred. The same patient suffered a refracture two months after the original trauma, which required a closed reduction. Metal removal was performed after 84 days (TIK) and 150 days (a-ESIN). The outcome in all patients was good.
Both a-ESIN and TIK are minimally invasive procedures that are technically easy to perform. Both methods are safe and lead to a complete restoration of the forearm's range of motion. The decisive advantage of a-ESIN is the possibility of postoperative immobilization-free rehabilitation.
干骺端-骨干交界区（MDJ）不稳定型前臂骨折的治疗仍存在争议。各类固定方法的主要缺点包括侵入性、技术上不可行或患者接受度低。本研究报告了顺行弹性髓内钉固定术（a-ESIN）与经骨骺髓内克氏针固定术（TIK）治疗MDJ不稳定型前臂骨折后的结果。
前臂的MDJ定义为双侧前臂骨关节上方的正方形面积减去仅桡骨干骺端上方的正方形面积。回顾性分析了在一家大型儿科创伤中心接受a-ESIN（后期治疗组）或TIK（早期治疗组）治疗MDJ不稳定型前臂骨折的40例16岁以下连续患者的数据。
第一组（TIK组）的平均年龄略低（TIK组 = 7.42岁；a-ESIN组 = 10.5岁）。50%的病例发现合并尺骨骨折，其中10/20例（TIK组）和6/20例（a-ESIN组）采用经典顺行弹性髓内钉固定术治疗。所有TIK组病例及3例a-ESIN组病例均进行了额外的石膏固定。TIK组术后未发生并发症、畸形或功能受限。a-ESIN组术后，19/20例患者病程顺利，内固定稳定且愈合良好，无轴向畸形。1例患者出现暂时性感觉功能障碍。该患者在初次创伤后两个月发生再骨折，需要进行闭合复位。分别在术后84天（TIK组）和150天（a-ESIN组）取出内固定。所有患者的预后均良好。
a-ESIN和TIK均为微创手术，技术操作简单。两种方法均安全有效，可使前臂活动范围完全恢复。a-ESIN的决定性优势在于术后无需固定即可进行康复训练。
