Outcome Analysis of Distal End Radius Fractures Managed With Antegrade Intramedullary K-wire Fixation

Awasthi, Abhiram; Jadhav, Shivshankar; Taywade, Shounak; Salwan, Ankur; Khan, Khizar

doi:10.7759/cureus.30512

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…Antegrade ESIN (a-ESIN) is another alternative that has always been avoided due to a high risk of injury to the posterior interosseous nerve (PIN). Nevertheless, antegrade nailing of the radius has been described for more than 20 years in adults [14,15] with different implant entry points [16]. The posterolateral approach described by Thompson has proven its suitability for osteosynthetic xation of distal forearm fractures [17].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Unstable Forearm Fractures at the Metaphyseal-Diaphyseal Junction in Children: Antegrade ESIN vs Transepiphyseal Intramedullary K-wire Fixation

Dietzel,

Scherer,

Spogis

et al. 2024

Preprint

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Background Treatment of unstable forearm fractures in the metaphyseal-diaphyseal junction (MDJ) zone is still a matter of debate. Major drawbacks of all types of fixations include either invasiveness, technical impracticality, or lack of acceptance by patients. This study reports results after antegrade ESIN (a-ESIN) compared to transepiphyseal intramedullary K-wire (TIK) for unstable MDJ forearm fractures. Methods The MDJ of the forearm was defined as the square over the joints of both forearm bones subtracted with the square over the metaphysis of the radius alone. The data of 40 consecutive patients < 16 years of age who were treated either by a-ESIN (later treatment period) or TIK (early treatment period) for an unstable MDJ forearm fracture at a single high-volume pediatric trauma center were retrospectively analyzed. Results The average age was slightly lower in the first group (TIK = 7.42 years; a-ESIN = 10.5 years). An additional ulna fracture was found in 50% of cases and was treated with a classic antegrade ESIN in 10/20 (TIK) and 6/20 cases (a-ESIN). Additional plaster cast immobilization was performed in all cases with TIK and in three cases with a-ESIN. After TIK, no complication, malalignment, or functional limitation occurred. After a-ESIN, 19/20 patients had an event-free course with stable retention and healing without axial malalignment. In one case, a temporary sensor dysfunction occurred. The same patient suffered a refracture two months after the original trauma, which required a closed reduction. Metal removal was performed after 84 days (TIK) and 150 days (a-ESIN). The outcome in all patients was good. Conclusion Both a-ESIN and TIK are minimally invasive procedures that are technically easy to perform. Both methods are safe and lead to a complete restoration of the forearm's range of motion. The decisive advantage of a-ESIN is the possibility of postoperative immobilization-free rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Treatment of Unstable Forearm Fractures at the Metaphyseal-Diaphyseal Junction in Children: Antegrade ESIN vs Transepiphyseal Intramedullary K-wire Fixation

Dietzel,

Scherer,

Spogis

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Treatment of unstable forearm fractures at the metaphyseal-diaphyseal junction in children: antegrade ESIN vs. transepiphyseal intramedullary K-wire fixation

Dietzel,

Scherer,

Spogis

et al. 2024

Eur J Trauma Emerg Surg

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Background Treatment of unstable forearm fractures in the metaphyseal-diaphyseal junction (MDJ) zone is still a matter of debate. Major drawbacks of all types of fixations include either invasiveness, technical impracticality, or lack of acceptance by patients. This study reports results after antegrade ESIN (a-ESIN) compared to transepiphyseal intramedullary K-wire (TIK) for unstable MDJ forearm fractures. Methods The MDJ of the forearm was defined as the square over the joints of both forearm bones subtracted with the square over the metaphysis of the radius alone. The data of 40 consecutive patients < 16 years of age who were treated either by a-ESIN (later treatment period) or TIK (early treatment period) for an unstable MDJ forearm fracture at a single high-volume pediatric trauma center were retrospectively analyzed. Results The average age was slightly lower in the first group (TIK = 7.42 years; a-ESIN = 10.5 years). An additional ulna fracture was found in 50% of cases and was treated with a classic antegrade ESIN in 10/20 (TIK) and 6/20 cases (a-ESIN). Additional plaster cast immobilization was performed in all cases with TIK and in three cases with a-ESIN. After TIK, no complication, malalignment, or functional limitation occurred. After a-ESIN, 19/20 patients had an event-free course with stable retention and healing without axial malalignment. In one case, a temporary sensor dysfunction occurred. The same patient suffered a refracture two months after the original trauma, which required a closed reduction. Metal removal was performed after 84 days (TIK) and 150 days (a-ESIN). The outcome in all patients was good. Conclusion Both a-ESIN and TIK are minimally invasive procedures that are technically easy to perform. Both methods are safe and lead to a complete restoration of the forearm’s range of motion. The decisive advantage of a-ESIN is the possibility of postoperative immobilization-free rehabilitation.

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Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

Vissarionov,

Bolshakov

2024

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

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Outcome Analysis of Distal End Radius Fractures Managed With Antegrade Intramedullary K-wire Fixation

Cited by 4 publications

References 14 publications

Treatment of Unstable Forearm Fractures at the Metaphyseal-Diaphyseal Junction in Children: Antegrade ESIN vs Transepiphyseal Intramedullary K-wire Fixation

Treatment of Unstable Forearm Fractures at the Metaphyseal-Diaphyseal Junction in Children: Antegrade ESIN vs Transepiphyseal Intramedullary K-wire Fixation

Treatment of unstable forearm fractures at the metaphyseal-diaphyseal junction in children: antegrade ESIN vs. transepiphyseal intramedullary K-wire fixation

Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

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