Instabile kindliche Femur- und Unterarmschaftfrakturen - Vergleich zwischen konservativer Behandlung und stabiler intramedullärer Schienung -

Abstract

Elastic intramedullary nailing represents a new surgical concept in the treatment of unstable shaft fractures in children. The present case control study wanted to examine the superiority of intramedullary nailing in comparison to conservative therapeutic concepts which had been applied so far. 13 children with forearm fractures who were treated initially by conservative measures were compared to 13 other children who received a primary intramedullary nailing. With femoral fractures, 12 children were included in each group. In each patient pair age, type and localisation of the fracture were comparable. During the observation period (until the termination of final therapeutic measures or until the third year after injury) we examined clinical variables and subjective findings. Both therapeutic concepts led to comparably good functional results. Also subjective judgement of the therapeutic success did not differ between groups. However, with intramedullary nailing of shaft fractures of the femur the mean hospital length of stay (7.0 +/- 3.5 days) was significantly shorter than with initial conservative treatment (36.5 +/- 2.2 days, P < 0.05). Irrespective of the localisation of the fracture intramedullary nailing required significantly less x-ray examinations during the observation period. These results suggest intramedullary nailing to be the procedure of choice to treat unstable forearm and femoral fractures in children.

Clinical Outcomes of Management of Pediatric Diaphyseal Forearm Fractures Using Flexible Elastic Nailing

“…Secondary displacement, which is a particular problem for conservative management of these injuries, and leads to malunion or need for re-reduction, is very seldom observed in patients treated with TENS. A comparative study showed that fewer radiologic investigations were necessary after TENS than after conservative therapy (26) , in our study no such complication observed. Another typical complication of forearm fractures treated conservatively is refracture, which has been quoted to occur in (6 10%) of patients (9) .…”

“…More studies (24,25) have shown that even 101 of angulation can lead to decreased rotational mobility. Hertlein (26) showed in a prospective, comparative study that the presence of angulation greater than 10° was significantly rarer (P<0.05) in patients treated with TENS than in patients treated conservatively. In a study from Lee et al (27) , all forearm fractures healed after TENS with angulation less than 5°.…”

Die elastisch stabile intramedulläre Nagelung (ESIN) instabiler kindlicher Unterarmfrakturen

“…Von mehreren Untersuchern [5,30] konnte gezeigt werden, dass schon Achsenfehler von 10 Grad die Unterarmumwendbewegungen einschränken können. Hertlein [9] konnte in einer prospektiv vergleichenden Untersuchung zeigen, dass nach der ESIN signifikant (p < 0,05) weniger Achsenfehler > 10 Grad auftreten als bei der konservativen Behandlung. In einer Untersuchung von Lee u. Mitarb.…”

“…In einer vergleichenden Untersuchung konnte gezeigt werden, dass nach der ESIN insgesamt weniger Röntgenkontrollen erforderlich sind als bei der konservativen Behandlung[9].Das für die konservative Behandlung typische Problem einer Refraktur, deren Häufigkeit mit 6 ± 10%[13] angegeben wird, ist nach der ESIN mit etwa 0,5 %[27] eine Rarität. In einer aktuellen Untersuchung[20] wird beschrieben, dass die Reposition einer Refraktur, die einen Monat nach der Osteosynthese auftrat, bei liegenden Implantaten durchgeführt wurde und die Fraktur danach ausheilte.Shoemaker[31] berichtete in seinem Krankengut von 32 Patienten über 3 sekundäre Repositionsverluste sowie 2 Refrakturen, die nach der Metallentfernung auftraten.…”