The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment

Abstract

<p><strong>Aim</strong> <br />Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/forearm fracture.<br /><strong>Methods<br /></strong> A total of 43 patients who presented with distal radius/forearm fractures were enrolled and divided into two groups: 23<br />patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS).<br /><strong>Results</strong> <br />In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third<br />month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05).<br /><strong>Conclusion</strong> <br />The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician<br />is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference.<br />The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.</p>

Clinical and Radiological Outcomes of Paediatric Forearm Fractures of the Radius and Ulna Following Fixation by Intramedullary Nailing or Plating: A Systematic Review

“…Finally, poor was any other outcome or greater than 90 degrees loss of forearm rotation [9]. One of the studies reported functional outcomes in terms of objective quality of life and wrist function by employing different scoring parameters like the Mayo wrist score [14].…”

“…They are largely categorised by most authors into major and minor complications. Major complications include nonunion, delayed union, mal-union, and implant failure as mentioned in a number of studies [4,8,12,14]. On the other hand, this review refers to minor complications such as SSI, radial nerve palsy, as well as bursitis.…”

“…One study used a clinician-completed scoring system to assess the level of disability in the wrist, assess pain, range of motion and grip strength. It also employed a reliable patient-reported outcome measure, Quick DASH, which is a validated scoring system [14]. Not all included studies evaluated functional outcomes nor had sufficient data on how they assessed this outcome.…”

Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique

“…ESIN application with a poller K-wire is a minimally invasive technique, and no delayed union or neurovascular damage was observed due to the application. OR-IF is recommended for older children because it provides more stable fixation and satisfactory reduction [ 12 ]. However, some complications could be seen, such as more extensive skin scars, slower healing, a high rate of refractures, and growth plate injury [ 39 , 40 ].…”

“…It can lead to severe but rare complications such as growth plate disorder and iatrogenic fracture associated with these surgical techniques. Considering skeletal maturity, open reduction and internal fixation (OR-IF) are becoming popular in current practice in older pediatric cases [ 12 ]. In our clinical practice, although we prefer OR-IF in patients over 14 years of age or who have completed skeletal maturity, we use more minimally invasive intramedullary fixation methods in cases that have not completed skeletal maturity.…”