Nair Vinod, Kumar Harsh S, Devarmani Shivappa, Nair Abhishek
Orthopaedics, Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Aug 5;16(8):e66175. doi: 10.7759/cureus.66175. eCollection 2024 Aug.
A significant amount of all paediatric fractures are forearm fractures involving the radius, ulnar shaft, or both. As surgical stabilisation lowers the likelihood of re-displacement, surgical intervention is currently recommended over conservative treatment of such fractures involving significant displacement and angulation. Open reduction and plating can better anatomically repair the majority of fractures. Bracing is necessary for the first six to eight weeks after nailing since nailing does not give a rigid fixation. External bracing is generally not necessary for plating. In our facility, paediatric diaphyseal forearm fractures are typically treated using titanium elastic nail system (TENS) nailing. However, there are occasional instances where the primary fracture site refractures after surgery, particularly in diaphyseal forearm fractures involving both bones. Our patient was a 12-year-old boy who had come to our facility with a left forearm radius shaft fracture and ulna shaft plastic deformation. The radius shaft fracture was fixed with TENS nailing, and the ulna shaft plastic deformation was corrected by the three-point bending method. Three months later, the patient came back with a refracture of the radius shaft. TENS nail removal, open reduction, and internal fixation of the radius shaft refracture were done with a plate and screws. Anatomic reduction of forearm fractures, open reduction, and the use of plate fixation enable a more thorough correction of malrotation and restoration of the radial bow, allowing for an early range of motion. Since the TENS nail is not a locking device, there is always some amount of mobility at the fracture site, causing loss of reduction, chances of implant failure, and non-union. So primary plating, especially in cases of forearm fractures, appears to be a better option compared to primary TENS nailing in juvenile patients.
所有小儿骨折中有相当一部分是涉及桡骨、尺骨干或两者的前臂骨折。由于手术固定可降低再次移位的可能性，目前对于此类存在明显移位和成角的骨折，推荐手术干预而非保守治疗。切开复位钢板内固定能更好地在解剖学上修复大多数骨折。髓内钉固定后最初的六至八周需要使用支具，因为髓内钉固定并不牢固。钢板固定一般不需要外部支具。在我们机构，小儿尺桡骨干骨折通常采用钛弹性髓内钉系统（TENS）进行固定。然而，偶尔会出现术后原骨折部位再次骨折的情况，特别是在涉及双骨的尺桡骨干骨折中。我们的患者是一名12岁男孩，因左前臂桡骨干骨折和尺骨干部塑性变形前来我院。桡骨干骨折采用TENS髓内钉固定，尺骨干部塑性变形通过三点弯曲法进行矫正。三个月后，患者因桡骨干再次骨折复诊。取出TENS髓内钉，对桡骨干再次骨折进行切开复位，并用钢板和螺钉进行内固定。前臂骨折的解剖复位、切开复位以及钢板固定的使用能够更彻底地矫正旋转畸形并恢复桡骨弓，从而允许早期进行活动。由于TENS髓内钉不是锁定装置，骨折部位总会有一定程度的活动，导致复位丢失、植入物失败和骨不连的风险。因此，对于青少年患者，初次钢板固定，尤其是在前臂骨折的情况下，似乎比初次TENS髓内钉固定是更好的选择。
