A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures

Freese, Krister; Faulk, Leonard W.; Palmer, Claire; Baschal, Robin; Sibbel, Sarah E.

doi:10.1016/j.injury.2018.08.023

Cited by 20 publications

(36 citation statements)

References 26 publications

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“…The complication rate for plate fixation range from 16.5 to 33%. Complications include nonunion, malunion, nerve damage, more commonly secondary to ulnar fixation, scar problems, wound infection, hardware failure, refracture [60][61][62].…”

Section: Platingmentioning

confidence: 99%

“…Baldwin et al [ 62 ] found similar functional outcomes and complication rate between IM nailing and plate and screw fixation. Freese et al [ 60 ] found 55% of major complications in the IM nails group and no major complications in the plate group. Moreover, they found that the patient treated with IM nailing needed of more time to heal and achieve radiographic union.…”

Section: What Type Of Fixation Should You Choose?mentioning

confidence: 99%

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Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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Purpose This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option. Methods We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review. Results Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation. Conclusions There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.

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Section: Platingmentioning

confidence: 99%

Section: What Type Of Fixation Should You Choose?mentioning

confidence: 99%

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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“…In children aged 10-16 years with double bone forearm fractures, the union time in the TEN group was observed to be longer than in the children undergoing open reduction [21,22]. However, most studies reported that there was no difference between the two groups in terms of union times [19,23,24].…”

Section: Discussionmentioning

confidence: 96%

“…In comparative studies, it was noted that the duration of the operation was significantly shorter in the TEN group [19][20][21][22][23][24]. In patients who were performed TEN, fracture reduction, implant removal and total operation times were found to be significantly shorter compared with the PO group.…”

Section: Discussionmentioning

confidence: 97%

Comparison of two different surgical treatments of forearm double diaphysis fractures in adolescents

2020

Ann Clin Anal Med

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Aim: In this study, it was aimed to compare the clinical and radiological results of the two different surgical methods for the treatment of forearm double bone diaphysis fractures in children at early and mid-adolescence (ages 10-16). Materials and Methods: Children aged between 10 and 16 years who underwent surgical treatment for a forearm double bone fracture between the years 2015-2019 were evaluated retrospectively after the approval of the local ethics committee. The patients were separated into two groups: TEN group included 34 patients for whom both bones were fixated with TEN following closed reduction; plate-screw osteosynthesis (PO) group included 18 patients who had fixation with PO following open reduction. Results: A total of 52 children with forearm double bone diaphysis fracture with the mean age of 12.40±1.79 (10-16) years, 86.5% (n=45) of whom were males and 53.8% (n=28) had left side fracture were followed up for 30.40±14.03 (12-64) months. When the data of both groups were compared, it was observed that average union time was shorter compared with the PO group and the difference was statistically significant (p=0.007). When the functional results and complication rates of the two groups were compared, there was no statistically significant difference found between the two groups (p=0.756 and p=0.052, respectively). When the number of radiographs of both groups was compared, it was observed that the number of radiographs during the operation, during implant extraction, and total radiography was higher in the TEN group compared with the PO group and that the difference was statistically significant (p=0.000, p=0.002, p=0.000, respectively). Discussion: TEN after closed reduction can be safely preferred for pre-adolescent period children with adequate remodeling capacity and incomplete skeletal maturity because of its positive outcomes including less operation and hospital stay duration, fast union, better cosmetic results. However, plate-screw following open reduction can be preferred for mid-adolescent period children with complete or near-complete skeletal maturity and limited remodeling capacity because of its positive aspects such as rigid fixation, anatomic reduction, and less radiation exposure.

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“…In comparison to elastic stable intramedullary nailing, good clinical results could be published for locked intramedullary implants [17]. Some authors described an increased complication rate for intramedullary techniques compared to the pediatric population [18,19]. Especially the risk of non-union increases with increasing age due to insufficient stability of unlocked intramedullary implants [20,21].…”

Section: Discussionmentioning

confidence: 99%

Nailing of diaphyseal ulna fractures in adults—biomechanical evaluation of a novel implant in comparison with locked plating

et al. 2020

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Background: Adult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect. Methods: Ten pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods.Results: The nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001).Conclusions: Intramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.

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A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures

Cited by 20 publications

References 26 publications

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Comparison of two different surgical treatments of forearm double diaphysis fractures in adolescents

Nailing of diaphyseal ulna fractures in adults—biomechanical evaluation of a novel implant in comparison with locked plating

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