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Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review

Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described...

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Autores principales: Cintean, Raffael, Eickhoff, Alexander, Pankratz, Carlos, Strauss, Beatrice, Gebhard, Florian, Schütze, Konrad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369287/
https://www.ncbi.nlm.nih.gov/pubmed/35956095
http://dx.doi.org/10.3390/jcm11154478
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author Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
author_facet Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
author_sort Cintean, Raffael
collection PubMed
description Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.
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spelling pubmed-93692872022-08-12 Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review Cintean, Raffael Eickhoff, Alexander Pankratz, Carlos Strauss, Beatrice Gebhard, Florian Schütze, Konrad J Clin Med Article Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains. MDPI 2022-07-31 /pmc/articles/PMC9369287/ /pubmed/35956095 http://dx.doi.org/10.3390/jcm11154478 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title_full Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title_fullStr Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title_full_unstemmed Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title_short Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review
title_sort radial vs. dorsal approach for elastic stable internal nailing in pediatric radius fractures—a 10 year review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369287/
https://www.ncbi.nlm.nih.gov/pubmed/35956095
http://dx.doi.org/10.3390/jcm11154478
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