A percutaneous reduction technique for irreducible and difficult variant of paediatric distal radius and ulna fractures

Huang, Wei; Zhang, Xu; Zhu, Hongwei; Wang, Xianhui; Sun, Jiayuan; Shao, Xinzhong

doi:10.1016/j.injury.2016.02.011

Cited by 12 publications

(10 citation statements)

References 25 publications

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“…Considering that their dominant hands were not the same, more evaluating criterion such as score of disability of arm-shoulder-hand would be used for further assessment. Huang et al [4] reported 48 cases of irreducible distal radius fracture treated with percutaneous joystick having acquired an excellent-rate of 91.7% (44/48) and a good-rate of 8.3% (4/48).…”

Section: Discussionmentioning

confidence: 99%

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Antegrade elastic stable intramedullary nailing in treatment of irreducible distal radius fractures in diaphyseal-metaphyseal junction in children

Lin¹,

Liu²,

Hui³

2020

Preprint

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Purpose This paper aimed to study the method and outcome of antegrade elastic stable intramedullary nailing (ESIN) for irreducible distal radius fractures in diaphyseal-metaphyseal junction in children. Methods 27 irreducible distal radius fractures in children ranging in age from six to 13 years treated with closed reduction and antegrade ESIN from March 2017 to September 2018 were analyzed retrospectively. The series comprised 24 boys and three girls. 17 cases were double fractures in forearms and ten cases were single fractures of radius. Each case was treated with closed reduction, internal fixation of antegrade ESIN and plaster cast. ESIN was removed when fracture healed and remodelled well. Cooney modified Green-O'Brien wrist score was used to evaluate the wrist function. Ranges of motion (ROM) in bilateral wrists were contrasted at the final follow-up. P<0.05 was considered statistically significant in the difference. Results All the fractures healed four to six weeks post-operative. At the final follow-up (12-16 months), there was no statistical significance in ROM of bilateral wrists (all p>0.05). The mean Cooney modified Green-O'Brien wrist score was 93 (80-100) including 25 excellent (93%) and two good (7%) results. Conclusions The technique of antegrade ESIN is effective and minimal invasive for irreducible distal radius fractures in children. The criterion of proximal radius approach to implant ESIN should be studied further in minimal invasive therapy of fractures.

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Section: Discussionmentioning

confidence: 99%

“…But the rate of re-displacement of fractures is up to 39% [3] due to the interaction of muscles and interosseous membrane in forearm. Various techniques are applied for this fracture presently including crossed K-wires [4], opened reduction and…”

Section: Introductionmentioning

confidence: 99%

Antegrade elastic stable intramedullary nailing in treatment of irreducible distal radius fractures in diaphyseal-metaphyseal junction in children

Lin¹,

Liu²,

Hui³

2020

Preprint

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“…Therefore, when the tip of the ESIN was close to the fracture site, close reduction of the fracture was necessary. If reduction is difficult, a reduction pin can be used as a lever by applying it to the fragments to reduce the fracture, as introduced by Ann Chir Main [9,20]. After passing through the fracture site, the tip of the nail was advanced as closely as possible to the epiphysis to achieve longer linear support at the fracture site without penetrating the epiphysis.…”

Section: Discussionmentioning

confidence: 99%

Antegrade elastic stable intramedullary nail fixation for paediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach

Han

2019

Injury

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Background and purpose: The treatment of paediatric distal radius diaphyseal metaphyseal junction (DRDMJ) fractures is a challenge. The purpose of this study was to introduce a new operative approach at the proximal "safe zone" of the posterior interosseous nerve (PIN) to treat paediatric DRDMJ fractures and analyse the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation. Methods: Thirty paediatric patients with unstable and displaced DRDMJ fractures were treated by antegrade ESIN fixation from November 2015 to September 2017. We created the entrance site at the posterolateral side of the proximal radius and 2~4 cm distal to the articular surface of the radius, using the ESIN to immobilise the fractures. In the study, we reviewed patient demographics, complications, time until removal, and intraoperative time for hardware removal. Results: Complete fracture healing was achieved between 6 and 12 weeks after surgery. Except for 3 patients presenting with irritation of the skin, we did not observe any complications. Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, non-union, or refracture was noted. Conclusions: The antegrade ESIN fixation is a minimally invasive, easy-to-learn, alternative operative method to treat paediatric DRDMJ fractures.

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“… 1 However, for those who had significantly angulation rotation and displacement fractures of the distal radius, the fractures were mostly fixed by manual repositions combined with plaster for external fixation, or by closed reduction and percutaneous K-wire for internal fixation combined with plaster for external fixation. 2 , 3 , 4 Even though some cases suffering from fracture malunion to a certain extent, the distal radius fractures in children could be gradually remodeled. 5 , 6 For patients with irreducible distal radius fractures following a failed manual reposition, traction and reposition may not reach to a good level and may even lead to severe damage to soft tissues and nerve incarceration.…”

Section: Discussionmentioning

confidence: 99%

Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture

Zujie

Liu

et al. 2018

Chinese Journal of Traumatology

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PurposeTo explore the advantages of palmar approach with Kirschner-wire (K-wire) fixation in the treatment of children's distal radius extension type fracture.MethodsThirty patients, average age of 8.5 years ranging from 5 to 13 years, with distal radius extension type fracture and undergoing a failed manual reposition in our hospital were included, and treated by palmar approach with K-wire fixation between May 2014 and December 2017. Among these patients (21 male and 9 female), 5 patients had chronic injuries over 10 days, and 6 patients had fracture of the distal radius epiphysis. The time between injury and treatment ranged from 1 to 30 days. Among them, 11 patients with right-sided fractures and 19 patients with left-sided fractures were operated via the palmar longitudinal incision approach.ResultsThe results were evaluated after an average of 18 months ranging from 5 to 36 months after operation. The recovery time of fracture was from 4 to 8 weeks and all incisions were primary healing with an average of 6 weeks. Nonunion, delayed union, early closure of distal radial epiphysis, and wrist varus/valgus deformity were not found in all the cases. Based on Gartland and Wereley wrist score assessment undertaken three months after operation, excellent scores were achieved in 24 cases, good scores in 3 cases, acceptable scores in 3 cases.ConclusionThe palmar approach with K-wire fixation via a front longitudinal incision in the treatment of children's distal radius extension type fracture has following advantages: (1) easy to reposition for both fresh and old fractures; (2) less damage to surrounding tissues and epiphysis; (3) quick recovery. It is suitable to treat children's distal radius extension type fracture.

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A percutaneous reduction technique for irreducible and difficult variant of paediatric distal radius and ulna fractures

Cited by 12 publications

References 25 publications

Antegrade elastic stable intramedullary nailing in treatment of irreducible distal radius fractures in diaphyseal-metaphyseal junction in children

Antegrade elastic stable intramedullary nailing in treatment of irreducible distal radius fractures in diaphyseal-metaphyseal junction in children

Antegrade elastic stable intramedullary nail fixation for paediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach

Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture

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