Treatment Of Both-bone Forearm Fractures Research Articles

Clinical effect of Kirschner wire intramedullary fixation in the treatment of pediatric both-bone forearm fractures at high altitude area

To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area. From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard. The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up. Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.

Evaluating the safety and feasibility of a new surgical treatment for forearm fractures in older children: study protocol for a randomised controlled trial

BackgroundBoth-bone forearm fractures are a common fracture, accounting for 3.4% of all paediatric fractures. For now, elastic stable intramedullary nailing (ESIN) and open reduction and internal fixation (ORIF) are the common surgical procedures for paediatric both-bone forearm fractures. Both ORIF and ESIN have their shortcomings. Therefore, we need to find another surgical treatment which can decrease the rate of complications and improve the clinical efficacy. Our study plans to test hybrid fixation, using an ESIN fixation for the radius and an ORIF for the ulna. Our study will conduct a randomised controlled trial (RCT) comparing double plate fixation with hybrid fixation for treatment of both-bone forearm fractures in older children between 10 and 16 years of age. The objectives of this trial are to compare the effectiveness between double plate fixation and hybrid fixation for treatment of both-bone forearm fractures in older children.MethodsAn RCT will be conducted, and the participants included will be randomly divided into either the hybrid fixation group or the double plate fixation group, at a ratio of 1:1. The primary clinical outcome measures are the Disabilities of the Arm, Shoulder and Hand score and radiological evaluation. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery and complications. Follow-up will be conducted at 2 weeks and 1, 3, 6 and 12 months postoperatively.DiscussionThe trial will provide a new surgical treatment for forearm fractures in older children. Our hypothesis is that there is no clinically relevant difference in the primary outcome measures between the two treatment groups.Trial registrationChinese Clinical Trial Registry, ChiCTR1800018060. Registered on 26 August 2018.

A comparative study of both bone forearm fractures treated with intramedullary nailing vs plating in adults

Background: The aim of this paper was to study the diaphyseal fractures of radius and ulna treated with nail/plate in adults and to choose the best modality of treatment.Methods: From May 2017 to December 2018 in Department of Orthopaedics, Krishna institute of medical sciences, Karad, total of 30 patients of both bones forearm fractures were treated. 15 were treated with open reduction and internal fixation using DCP plating or 1/3rd tubular plate and 15 with intramedullary nailing with radius and ulna nail. 30 patients were available for the follow up. Follow up was done for one year. Functional results were assessed by using Anderson et al criteria.Results: The time required for surgery in plating group was 62 minutes, and 42 minutes for nailing group. Average time of radiological union for radius & ulna was 13 weeks in nailing group and 16 weeks in plating group. There was one case of radiological non union with ulna nailing and there was no other associated complications.Conclusion: We conclude that open reduction and internal fixation with plating is the gold standard procedure for the treatment of both bone forearm fractures in adults. Intramedullary nailing is a less attractive alternative compared to plating as the normal movements are hampered.

Pseudo-Volkmann Contracture: A Case Report and Review of the Current Literature.

Background:Unlike the usual Volkmann contracture as a complication of pediatric forearm fracture, pseudo-Volkmann contracture is not a sequela of ischemia, but rather of a mechanical entrapment of the flexor myotendinous units in the fracture or adhesions.Methods:PubMed search of the English literature was performed using the terminology entrapment and fracture and pseudo-Volkmann.Results:Thirteen articles were identified that described cases of pseudo-Volkmann contracture in pediatric both-bone forearm fractures. Totally, 26 cases were reported in the English literature. Additionally, we describe two more cases in detail.Discussion:Pseudo-Volkmann contracture is well described but uncommon. It most commonly involves the ring finger flexor digitorum superficialis but can occur in all fingers. This entrapment can be identified acutely with intentional examination by confirming full passive motion of the fingers after preferred treatment of both-bone forearm fractures in the pediatric patient. When contracture is identified on examination, surgical intervention to clear the entrapment from the fracture is effective and produces excellent results.

Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases

Le but de notre étude est de décrire les complications de l'embrochage centromédullaire élastique stable (ECMES) dans le traitement des fractures diaphysaires des deux os de l'avant-bras chez l'enfant. Entre janvier 2009 et décembre 2013, 87 enfants présentant des fractures diaphysaires des os de l'avant-bras ont été traités par embrochage centro-médullaire élastique stable par des broches de Métaizeau. Il s'agissait de 76 garçons et 11 filles d'âge moyen 12 ans. L'embrochage a été réalisé d'emblée dans 50 cas et suite à un déplacement secondaire sous plâtre dans les autres. Les deux os ont été embrochés dans tous les cas. L'immobilisation plâtrée était systématique pour tous les malades pendant une durée moyenne d'un mois. Les broches ont été enlevées au bout d'environ 6 mois en moyenne. Les résultats fonctionnels ont été étudiés avec un recul moyen de 10 mois. Les complications ont été marquées par 14 infections superficielles, 2 cas d'ostéites sur matériel, 3 cas de refracture, 3 cas de pseudarthrose, 2 cas de retard de consolidation et une synostose radio-cubitale proximale. Bien que l'embrochage centro-médullaire soit une méthode d'ostéosynthèse idéalement adaptée aux enfants, il reste plus invasif que le traitement orthopédique. Ses indications doivent rester dans les limites de celui ci.

Prospective comparative study of three internal fixation methods for treatment of both-bone forearm fractures in older children

Objective To evaluate and compare the outcomes of three internal fixation methods, ulna compression plate and radial elastic stable intramedullary nailing (ESIN), double ESIN and double plating, for the treatment of both-bone forearm fractures in older children. Methods From February 2004 to July 2008, 45 older children with both-bone forearm fractures that failed manual closed reduction or were unstable were recruited for the prospective comparative study. They were randomized into 3 groups with 15 each: who were treated with ulna compression plate and radial elastic stable intramedullary nailing (ESIN) (group A), double ESIN (group B) and double plating (group C). The intraoperative and perioperative indexes, the radiographic findings, the clinical outcomes and postoperative complications were compared. Results Group A and group B resulted in a lower blood loss and shorter surgery time than group C (statistically significant). However no significant differences were found between group A and group B. There was statistically significant difference on tourniquet use time among the three groups, group B being shorter than group A and group C. There was no significant difference on postoperative pain score within 5 days after the surgery among the three groups. Fracture union rate of group A at 3 months was significantly higher than group B, while no significant differences were found between group B and group C and between group A and group C. There was no statistically significant difference on fracture union among the three groups at 6 months. The incidence of loss of forearm rotation and complications was lower in group A than in group B and group C, however the difference was not statistically significant. Conclusion Based on surgery trauma, incidence of fracture union, clinical outcomes and complications, ulna compression plate and radial elastic stable intramedullary nailing shows superiority in the treatment of both-bone forearm fractures in older children. However double ESIN has the advantages of being minimally invasive and easy for secondary hardware removal. Key words: Fractures; bone; Child; Prospective studies; Literal fiatior

Compartment syndrome following intramedullary fixation of pediatric forearm fractures.

This study was designed to evaluate the incidence of compartment syndrome (CS) resulting from the treatment of both-bone forearm fractures in children. A retrospective analysis of 285 consecutive children who presented with both-bone forearm fractures was performed. Of 235 closed injuries, 205 were treated with closed reduction and casting; none of these patients developed CS. Thirty of the closed injuries were treated with closed reduction and intramedullary fixation; three of these patients (10%) developed CS. Fifty patients sustained open fractures and were treated with debridement and open reduction with intramedullary pinning; CS developed in three of these patients (6%). The eighty patients treated with intramedullary fixation had an increased incidence of CS compared with the 205 patients treated with closed reduction and casting (P < 0.001). Within the group of patients who had surgery, patients with longer operative times and more use of intraoperative fluoroscopy were at higher risk of developing CS.

Both-Bone Forearm Fractures in Children

Treatment of both-bone forearm fractures remains a difficult dilemma for the orthopedist. We assessed the results of 33 children treated with closed reduction and a long-arm cast using traction with finger traps in neutral rotation. Patients were grouped according to age and analyzed for residual angulation and range of motion (ROM). Despite some residual angulation and loss of rotation, all patients were fully active with no functional restriction at follow up. For patients 10 years old or younger with less than 30 degrees of post-casting angulation, full ROM and minimal residual angulation on radiograph can be expected. For patients ages 11 to 15 years (the oldest patient in this series was 15), residual angulation is likely and approximately 60% of patients will have residual loss of less than or equal to 30 degrees of rotation. In spite of this, we found no evidence of functional loss at follow up. Our series supports the continued use of closed manipulation as an effective treatment in children with both-bone forearm fractures.