Closed Reduction and Percutaneous Pinning Versus Dorsal-Entry Elastic Intramedullary Nailing Estudio comparativo entre fijación percutánea con clavijas y clavos elásticos de titanio.
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Published:
Jun 25, 2022
Keywords:
Distal radius fractures, adolescents, treatment, elastic intramedullary nails, percutaneous pinning
Main Article Content
Abstract
Objective: To compare results and complications of closed reduction percutaneous pinning (CRPP) versus dorsal entry elastic intramedullary nails (ESIN).
Materials and Methods: Radiographs were evaluated to determine angular deformities at the time of radiographic union. Complications were graded with a modification of the Clavien-Dindo classification.
Results: The CRPP group consisted of 17 patients (Group A) whereas the ESIN group consisted of 19 patients (Group B). The average age of the patient cohort was 12.5±1.6 years. The average follow-up was 27.6±16.6 months. The demographic data revealed no differences between groups (p> 0.05). Patients treated with ESIN required a shorter immobilization time (2.8±1.8 versus 5.9±1.3 weeks, p 0.00029). One patient in each group presented an angulation >10° at the time of consolidation. The complication rate was higher in group A(18% versus 5.3%, p 0.27). According to the Clavien-Dindo classification, group A presented 2 type II (infection and granuloma), and 2 type III complications (loss of reduction). Group B presented one type I complication (implant prominence). Sixteen patients in group B underwent a second procedure for hardware removal. Two patients (11.8%) in group A required revision due to loss of reduction.
Conclusions: Both techniques are effective in stabilizing metaphyseal-diaphyseal fractures of the distal radius in the adolescent population. ESIN has the advantage of requiring a shorter immobilization time and fewer complications but needs a second surgery for implant removal. CRPP does not require anesthesia for implant removal, although it requires a longer postoperative immobilization, and has a higher complication rate.
Materials and Methods: Radiographs were evaluated to determine angular deformities at the time of radiographic union. Complications were graded with a modification of the Clavien-Dindo classification.
Results: The CRPP group consisted of 17 patients (Group A) whereas the ESIN group consisted of 19 patients (Group B). The average age of the patient cohort was 12.5±1.6 years. The average follow-up was 27.6±16.6 months. The demographic data revealed no differences between groups (p> 0.05). Patients treated with ESIN required a shorter immobilization time (2.8±1.8 versus 5.9±1.3 weeks, p 0.00029). One patient in each group presented an angulation >10° at the time of consolidation. The complication rate was higher in group A(18% versus 5.3%, p 0.27). According to the Clavien-Dindo classification, group A presented 2 type II (infection and granuloma), and 2 type III complications (loss of reduction). Group B presented one type I complication (implant prominence). Sixteen patients in group B underwent a second procedure for hardware removal. Two patients (11.8%) in group A required revision due to loss of reduction.
Conclusions: Both techniques are effective in stabilizing metaphyseal-diaphyseal fractures of the distal radius in the adolescent population. ESIN has the advantage of requiring a shorter immobilization time and fewer complications but needs a second surgery for implant removal. CRPP does not require anesthesia for implant removal, although it requires a longer postoperative immobilization, and has a higher complication rate.
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Ferreyra, A., Allende, F., Sánchez Benítez, J. E., Gramajo, F., Damiguella, B., Allende, V., & Masquijo, J. J. (2022). Closed Reduction and Percutaneous Pinning Versus Dorsal-Entry Elastic Intramedullary Nailing. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(3), 341-348. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1458
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Clinical Research
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References
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the radius in children associated with growth. J Bone Joint Surg Am 1989;71(8):1225-31. PMID: 2777851
2. Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3350 children. J Orthop
Trauma 1993;7(1):15–22. https://doi.org/10.1097/00005131-199302000-00004
3. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008;33(10):1911–23. https://doi.org/10.1016/j.jhsa.2008.10.013
4. Nielson AB, Simonsen O. Displaced forearm fractures in children treated with AO plates. Injury 1984;15(6):393–6. https://doi.org/10.1016/0020-1383(84)90204-3
5. Wyrsch B, Mencio GA, Green NE. Open reduction and internal fixation of pediatric forearm fractures. J Pediatr
Orthop 1996;16(5):644–50. https://doi.org/10.1097/00004694-199609000-00018
6. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal
intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg 2010;20(6):395–8.
https://doi.org/10.1055/s-0030-1262843
7. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous
pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop
2005;25(4):490-4. https://doi.org/10.1097/01.bpo.0000158780.52849.39
8. Van Leemput W, De Ridder K. Distal metaphyseal radius fractures in children: reduction with or without pinning. Acta Orthop Belg 2009;75(3):306-9. PMID: 19681314
9. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg 2014;99(3):269–75. https://doi.org/10.9738/INTSURG-D-13-00065.1
10. Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent
intramedullary nail. J Int Med Res 2016;44(1):122-30. https://doi.org/10.1177/0300060514566650
11. Kim BS, Lee YS, Park SY, Nho JH, Lee SG, Kim YH. Flexible intramedullary nailing of forearm fractures at the
distal metadiaphyseal junction in adolescents. Clin Orthop Surg 2017;9(1):101–8. https://doi.org/10.4055/cios.2017.9.1.101
12. Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing
to plating for both-bone forearm fractures in older children. J Pediatr Orthop 2008;28(4):403-9.
https://doi.org/10.1097/BPO.0b013e31816d71f2
13. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft
fractures in children: 85 cases. J Pediatr Orthop 1990;10(2):167–71. PMID: 2312694
14. Kang SN, Mangwani J, Ramachandran M, Paterson JMH, Barry M. Elastic intra-medullary nailing of paediatric
fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg Br 2011;93(2):262–5. https://doi.org/10.1302/0301-620X.93B2.24882
15. Clavien P, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of
surgical complications. Ann Surg 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
16. Pretell Mazzini J, Beck N, Brewer J, Baldwin K, Sankar W, Flynn J. Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted? Int Orthop 2012;36(7):1435–40. https://doi.org/10.1007/s00264-012-1493-x
17. Alemdaroğlu KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D. Risk factors in redisplacement of distal radial
fractures in children. J Bone Joint Surg Am 2008;90(6):1224-30. https://doi.org/10.2106/JBJS.G.00624
18. Battle J, Carmichael KD, Morris RP. Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures. J Pediatr Orthop B 2006;15(5):370-5. https://doi.org/10.1097/01202412-200609000-00012
19. Price CT, Rockwood CA, Wilkins KE, Beaty JH (eds.) Forearm fractures in children. 4th ed. Philadelphia:
Lippincott-Raven; 1996.
20. Wilkins KE (ed.). Operative management of upper extremity fractures in children. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 1994.
21. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of
diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013;33(6):598-607. https://doi.org/10.1097/BPO.0b013e3182a11d3b
22. Eamara P, Masquijo JJ. Enclavado endomedular elástico para el tratamiento de refracturas de antebrazo en niños. Rev Asoc Argent Ortop Traumatol 2018;83(4):242-7. https://doi.org/doi:10.15417/issn.1852-7434.2018.83.4.813
the radius in children associated with growth. J Bone Joint Surg Am 1989;71(8):1225-31. PMID: 2777851
2. Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3350 children. J Orthop
Trauma 1993;7(1):15–22. https://doi.org/10.1097/00005131-199302000-00004
3. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008;33(10):1911–23. https://doi.org/10.1016/j.jhsa.2008.10.013
4. Nielson AB, Simonsen O. Displaced forearm fractures in children treated with AO plates. Injury 1984;15(6):393–6. https://doi.org/10.1016/0020-1383(84)90204-3
5. Wyrsch B, Mencio GA, Green NE. Open reduction and internal fixation of pediatric forearm fractures. J Pediatr
Orthop 1996;16(5):644–50. https://doi.org/10.1097/00004694-199609000-00018
6. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal
intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg 2010;20(6):395–8.
https://doi.org/10.1055/s-0030-1262843
7. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous
pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop
2005;25(4):490-4. https://doi.org/10.1097/01.bpo.0000158780.52849.39
8. Van Leemput W, De Ridder K. Distal metaphyseal radius fractures in children: reduction with or without pinning. Acta Orthop Belg 2009;75(3):306-9. PMID: 19681314
9. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg 2014;99(3):269–75. https://doi.org/10.9738/INTSURG-D-13-00065.1
10. Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent
intramedullary nail. J Int Med Res 2016;44(1):122-30. https://doi.org/10.1177/0300060514566650
11. Kim BS, Lee YS, Park SY, Nho JH, Lee SG, Kim YH. Flexible intramedullary nailing of forearm fractures at the
distal metadiaphyseal junction in adolescents. Clin Orthop Surg 2017;9(1):101–8. https://doi.org/10.4055/cios.2017.9.1.101
12. Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing
to plating for both-bone forearm fractures in older children. J Pediatr Orthop 2008;28(4):403-9.
https://doi.org/10.1097/BPO.0b013e31816d71f2
13. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft
fractures in children: 85 cases. J Pediatr Orthop 1990;10(2):167–71. PMID: 2312694
14. Kang SN, Mangwani J, Ramachandran M, Paterson JMH, Barry M. Elastic intra-medullary nailing of paediatric
fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg Br 2011;93(2):262–5. https://doi.org/10.1302/0301-620X.93B2.24882
15. Clavien P, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of
surgical complications. Ann Surg 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
16. Pretell Mazzini J, Beck N, Brewer J, Baldwin K, Sankar W, Flynn J. Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted? Int Orthop 2012;36(7):1435–40. https://doi.org/10.1007/s00264-012-1493-x
17. Alemdaroğlu KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D. Risk factors in redisplacement of distal radial
fractures in children. J Bone Joint Surg Am 2008;90(6):1224-30. https://doi.org/10.2106/JBJS.G.00624
18. Battle J, Carmichael KD, Morris RP. Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures. J Pediatr Orthop B 2006;15(5):370-5. https://doi.org/10.1097/01202412-200609000-00012
19. Price CT, Rockwood CA, Wilkins KE, Beaty JH (eds.) Forearm fractures in children. 4th ed. Philadelphia:
Lippincott-Raven; 1996.
20. Wilkins KE (ed.). Operative management of upper extremity fractures in children. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 1994.
21. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of
diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013;33(6):598-607. https://doi.org/10.1097/BPO.0b013e3182a11d3b
22. Eamara P, Masquijo JJ. Enclavado endomedular elástico para el tratamiento de refracturas de antebrazo en niños. Rev Asoc Argent Ortop Traumatol 2018;83(4):242-7. https://doi.org/doi:10.15417/issn.1852-7434.2018.83.4.813