Buried intramedullary implants for paediatric forearm fractures. Does the refracture rate improve?

Abstract

IntroductionUnstable forearm fractures may require surgical management by reduction and osteosynthesis with intramedullary needles. This fixation should be removed early if it has been left exposed, but this could increase the risk of refracture in a bone in the period of remodelling. As an alternative we can keep the needles, buried subcutaneously, for a longer time, to protect the bone callus. ObjectiveTo assess whether there are differences between using exposed needles with respect to burying them in paediatric patients with forearm fractures. Our hypothesis is that by burying the needles we keep them longer by reducing forearm refractures. Material and methodsWe present a cohort of 75 paediatric patients with a forearm fracture between 2010 and 2016. Demographic data, surgical technique, complications and patient follow-up were collected. ResultsThe implants were left exposed in 50 patients and 25 buried. The average time of removal of the exposed implants was 6.8weeks and 17.6weeks in the buried ones. No significant differences were found in terms of consolidation (p=0.19) or immobilisation time (p=0.22). Regarding refractures, a greater number was observed in the exposed osteosynthesis group (4 patients) compared to only one case with buried osteosynthesis, but there were no significant differences (p=0.49). No postsurgical complications were detected and the functionality was excellent at the end of the follow-up in both groups. ConclusionLeaving implants buried in relation to skin exposed does not cause a decrease in the number of refractures or other complications, with adequate patient functionality in both cases.