Efficacy of percutaneous haemostat stroke-poking reduction plus close intramedullary nailing fixation for O'BrienII/III pediatric radial neck fracture

Abstract

Objective To evaluate the efficacy of percutaneous haemostat stroke-poking reduction plus close intramedullary nailing fixation versus percutaneous Kirshner-wire leverage for O'BrienⅡ/Ⅲ pediatric radial neck fracture. Methods From January 2014 to January 2016, a total of 62 children were operated for O'BrienⅡ/Ⅲ pediatric radial neck fractures due to falling from the height.There were 38 boys and 24 girls with an average operative age of 8.4 (4-14) years.The involved side was left (n=42) and right (n=20). According to the O'Brien classification scheme, the clinical types were II (n=36) and III (n=26). They were prospectively and consecutively randomized into haemostat group (n=32, percutaneous haemostat stroke-poking reduction plus elastic stable intramedullary nailing fixing) and Kirshner-wire group (n=30, percutaneous Kirshner-wire leverage plus elastic stable intramedullary nailing fixing) .Two groups were statistically compared in terms of operative duration, frequency of intraoperative radiography, fracture healing and postoperative Metaizeau score of elbow. Results All operations were successfully completed.During an average follow-up period of 10.7 (6-19) months, there was no onset of puncture wound infection or displacement of fracture fragment.All fractures demonstrated clinical and radiographic evidence of complete healing at an average of approximately 8 weeks.As compared with percutaneous Kirshner-wire leverage group, haemostat group achieved significantly shorter average operative duration [(16±2.7) vs (31±3.3) min], significantly lower average frequency of intraoperative radiography [(5.4±2.2 ) vs (13±3.4) times] and lower number of close reduction [ (2.3±1.4) vs (5.6±2.2) times](P 0.05). There was no onset of such major complications as deep infections, neurovascular injuries, fracture displacement or residual deformity.There was one case of dysplasia of proximal epiphysis in Kirshner-wire group. Conclusions As compared with percutaneous Kirshner-wire leverage, percutaneous haemostat stroke-poking reduction may enhance the probability of successful reduction at an initial attempt, reduce the number of close reduction and shorten operative duration.Effective, simple, reliable and mini-invasive with few complications, this procedure also minimizes the radiological exposure of both children and medical staff. Key words: Radius fractures; Fracture fixation, internal; Child; Prospective studies