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

Abstract

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.

Fractures of the proximal segments of the pediatric distal radial metaphysis exhibit less angular stability than fractures of the distal segments

“…Intrafocal pinning and K-wire fixation are usually performed for physeal and metaphyseal distal radial fractures [1]. However, treatment of radial DMJ fractures is challenging because this region has diaphyseal characteristics [2][3][4][5]9]. Conventional K-wire fixation occasionally fails, necessitating intramedullary nailing (IMN) for DMJ fractures because penetrating both cortices tends to be difficult in this region [2][3][4][5]9].…”

Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter?

“…Slongo considered those fractures not ideal indications for FN insertion. Recently, Du and Han [14] introduced a new operative approach to treat irreducible distal radius fracture in the diaphyseal-metaphyseal junction with satisfactory outcomes. ey used antegrade FN technique from the proximal radius with an entry point located 2.4 cm distal to the proximal articular surface of the radius at the dorsolateral aspect ( ompson approach).…”

Limited Open Reduction and Transepiphyseal Intramedullary Kirschner Wire Fixation for Treatment of Irreducible Distal Radius Diaphyseal Metaphyseal Junction Fracture in Older Children

“…In 2010, Lieber et al ( 2 ) proposed the term diametaphyseal transition (DMT) fracture for this injury. Since then, it has come to be known as diaphyseal–metaphyseal junction (DMJ) fracture ( 6 – 8 ). Manual reduction and plaster fixation is the usual treatment for distal radius fractures in children but it is not very effective for DMJ fracture.…”

“…Displacement is common even after successful reduction because of the small contact area between the two ends of the fracture. Currently, DMJ fracture is treated with open reduction and plate–screw fixation ( 3 , 9 , 10 ) or elastic intramedullary nailing fixation ( 2 , 3 , 6 – 8 , 11 ) or Kirschner wire fixation ( 2 – 4 , 10 ), or external fixation ( 3 , 12 ), the choice depending upon the age of the child, the type of fracture, and the preference of the surgeon. For older children (>10 years old), open reduction and internal fixation with plate and screw (ORIF-PS) is the usual choice.…”