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RESULTS OF TITANYUM ELASTIC INTRAMEDULLARY NAILING (TEN) IN FOREARM FRACTURES IN CHILDREN; A RETROSPECTIVE ANALYSIS OF 23 CASES

Year 2012, Volume: 1 Issue: 2, 43 - 48, 30.08.2012

Abstract

OBJECTIVE: The treatment of fractures of the forearm between the detection of the most
exclusive method of conservative treatment with closed reduction and plaster. Surgical
treatment of forearm fractures intramedullary TEN method to be used frequently. We
evaluated the treatment results of forearm fractures in patients with intramedullary TEN.
METHODS: The study of TEN and intramedullary bone forearm fractures in 23 patients
followed for at least 1 year (2 female, 19 male, mean. Age 12.2; range 7-18 years) were
included. Functional and radiological follow-up examinations were performed. Price criteria
were used for the functional assessment of patients. Median follow-up 20.1 (range 12-
48months) months.
RESULTS: .21 out of 23 patients (91.3%) observed union. We have two patients with nonunion
achieved union with conservative treatment with plaster. Average time to union of fractures
2.6 (range 1.5-6 months) months. Pin-track infection in 4 cases (17.4%) of these patients
improved with antibiotherapy and debridement, 3 cases (12.9%) were developed sensory
branch of n. ulnaris palsy. 1 case (4.3%) extensor pollicis longus (EPL) rupture in with the
thumb extensor indicis propius tendon transfer to provided extension. 1 case (4.3%) wire
malposition observed. Functionally, 91.3% (21 cases) have achieved excellent results.
CONCLUSION: We think that, good functional outcome, easy application technique, and less
soft tissue injury when implant removal of forearm fractures in children due to lead practice in
the surgical treatment of intramedullary TEN is a good option

References

  • Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups : a study of 3,350 children. J Orthop Trauma 1993 ; 7 : 15- 22.
  • 2. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10:705–12.
  • 3. Kay S, Smith C, Oppenheim WL. Both-bone midshaft forearm fractures in children. J Pediatr Orthop 1986 ; 6 :306-310.
  • 4. Jones K, Weiner D. The management of forearm fractures in children:a plea for conservatism. J Pediatr Orthop 1999;19:811–5.
  • 5. Fuller DJ, McCullough CJ. Malunited fractures of the forearm in children. J Bone Joint Surg (Br) 1982;64:364–7.
  • 6. Larsen E, Vittas D, Trop-Pedersen S. Remodeling of angulated distal forearm fractures in children. Clin Orthop 1988;237:190-5.
  • 7. Houshian S, Bajaj SK.Forearm fractures in children single bone fixation with elastic stable intramedullary nailing in 20cases.İnjury,İnt. J Care İnjured 2005;36:1421-6
  • 8. Blount WP. Forearm fractures in children. Clin Orthop 1967;51:93—107.
  • 9. Ortega R, Loder RT, Louis DS. Open reduction and internal fixation of forearm fractures in children. J Pediatr Orthop1996;16:651–4.
  • 10. Jones DJ, Henley MB, Schemitsch EH, Tencer AF. A biomechanical omparison of two methods of fixation of fractures of the forearm.J Orthop Trauma 1995 ; 9 : 198-206.
  • 11. Stern PJ, Drury WJ. Complication of plate fixation of forearm fractures. Clin Orthop 1983;175:25—9.
  • 12. Bhaskar, J.A.Roberts Treatment of unstable frectures of the forearm in children. J Bone Joint Surg.2001; 83-B:253–8.
  • 13. Fernandez FF, Egenolf M, Carsten C et al. Unstable diaphyseal fractures of both bones of the forearm in children :plate fixation versus intramedullary nailing. Injury 2005 :36: 1210-1216.
  • 14. Stern PJ, Drury WJ. Complications of plate fixation of fore arm fractures. Clin Orthop Relat Res 1983 ; 175 : 25-29.
  • 15. Qidwai SA. Treatment of diaphyseal forearm fractures in children by intramedullary kirschner wire.J Trauma.2001;50(2):303-7.
  • 16. Vander Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Ped Orthop 1998;18:9–13.
  • 17. Yung SH, Lam CY, Choi KY, Ng KW, Maffulli N, Cheng JCY. Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children. J Bone Joint Surg 1998;80:91–4.
  • 18. Pugh DMW, Galpin RD, Carey TP. Intramedullary Steinmann pin fixation of forearm fractures in children: long-term results. Clin Orthop 2000;376:39–48.
  • 19. Street DM. Intramedullary forearm nailing. Clin Orthop 1986;212:219–30.
  • 20. Cullen M. C.,Roy D. R.,Giza E., Crawfort H. A. Complications of intramedullary fixation of pediatric forearm fractures. J Pediatric Orthop.1998;18:14–21.
  • 21. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Ped Orthop 1990;10:167–71
  • 22. Küçükkaya M, Kabukçuoğlu YS, Tezer M, Eren OT, Kuzgun Ü. Çocuk Önkol Diafiz Kırıklarının Açık Elastik İntramedüller Fiksasyon ile Tedavisi. Acta Orthopaedica et. Traumatologica Turcica. 1998;32:103–6.
  • 23. Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 1999;19:329–37.
  • 24. Cumming D, Mfula N, Jones JW. Pediatric forearm fractures : the increasing use of elastic stable intramedullary nails. Int Orthop 2008 ; 32 : 421-423.
  • 25. Kapoor V, Theruvil B, Edwards SE et al. Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children. Injury 2005 ; 36 : 1221-1225.

ÇOCUK ÖNKOL KIRIKLARININ CERRAHİ TEDAVİSİNDE KANAL-İÇİ ELASTİK ÇİVİLEME; 23 HASTANIN GERİYE DÖNÜK ANALİZİ

Year 2012, Volume: 1 Issue: 2, 43 - 48, 30.08.2012

Abstract

AMAÇ: Önkol kırıklarının tedavisinde en seçkin yöntem kapalı redüksiyon ve alçı tespiti ile
uygulanan konservatif tedavidir. Cerrahi gereken önkol çift kırığı tedavisinde kanal-içi titanyum
elastik çivi(TEN) yöntemi sıklıkla kullanılmaktadır. Bizde önkol çift kırığı nedeniyle kanal-içi TEN
yapılan hastalarımızın tedavi sonuçlarını değerlendirdik.
YÖNTEMLER: Çalışmaya, önkol çift kırığı nedeniyle kanal-içi TEN yapılan ve en az 1 yıl süreyle
izlenen 23 hasta (2 kız,19 erkek; ort. yaş 12,2;dağılım7–18 yaş) alındı. Hastaların fonksiyonel
muayeneleri ve radyolojik takipleri yapıldı. Hastaların fonksiyonel değerlendirmesi Price
kriterlerine göre yapıldı. Ortalama takip süresi 20,1(dağılım 12-48ay)aydır.
BULGULAR: 23 hastanın 21’inde (%91,3) kaynama gözledik. Kaynamayan 2 hasta konservatif
alçı tedavisiyle kaynama elde ettik. Kırıkların ortalama kaynama süresi 2,6 (dağılım 1,5-6 ay)
aydır. Dört vakada pin dibi enfeksiyonu( % 17,4)gelişti bu hastalar antibiyoterapi ve debritman
ile iyileşti. Üç vakada n.ulnaris duyu dalı felci (% 12,9) gelişti. Ekstensör policis longus (EPL)
rüptürü gelişen 1 vakada (%4,3) ekstensör indicis propius tendon transferi ile başparmak
ekstansiyonu sağladık. 1 vakada(%4,3) tel malpozisyonu gözlemledik. Fonksiyonel olarak %91,3
(21 vaka) mükemmel sonuç elde ettik.
SONUÇ: Fonksiyonel sonuçlarının iyi olması, uygulama tekniğinin ve implant çıkartılmasının
kolay olması, daha az yumuşak doku hasarına yol açması nedeniyle çocuk önkol çift kırıklarının
cerrahi tedavisinde intramedüller TEN uygulamasının iyi bir seçenek olduğunu düşünüyoruz.

References

  • Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups : a study of 3,350 children. J Orthop Trauma 1993 ; 7 : 15- 22.
  • 2. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10:705–12.
  • 3. Kay S, Smith C, Oppenheim WL. Both-bone midshaft forearm fractures in children. J Pediatr Orthop 1986 ; 6 :306-310.
  • 4. Jones K, Weiner D. The management of forearm fractures in children:a plea for conservatism. J Pediatr Orthop 1999;19:811–5.
  • 5. Fuller DJ, McCullough CJ. Malunited fractures of the forearm in children. J Bone Joint Surg (Br) 1982;64:364–7.
  • 6. Larsen E, Vittas D, Trop-Pedersen S. Remodeling of angulated distal forearm fractures in children. Clin Orthop 1988;237:190-5.
  • 7. Houshian S, Bajaj SK.Forearm fractures in children single bone fixation with elastic stable intramedullary nailing in 20cases.İnjury,İnt. J Care İnjured 2005;36:1421-6
  • 8. Blount WP. Forearm fractures in children. Clin Orthop 1967;51:93—107.
  • 9. Ortega R, Loder RT, Louis DS. Open reduction and internal fixation of forearm fractures in children. J Pediatr Orthop1996;16:651–4.
  • 10. Jones DJ, Henley MB, Schemitsch EH, Tencer AF. A biomechanical omparison of two methods of fixation of fractures of the forearm.J Orthop Trauma 1995 ; 9 : 198-206.
  • 11. Stern PJ, Drury WJ. Complication of plate fixation of forearm fractures. Clin Orthop 1983;175:25—9.
  • 12. Bhaskar, J.A.Roberts Treatment of unstable frectures of the forearm in children. J Bone Joint Surg.2001; 83-B:253–8.
  • 13. Fernandez FF, Egenolf M, Carsten C et al. Unstable diaphyseal fractures of both bones of the forearm in children :plate fixation versus intramedullary nailing. Injury 2005 :36: 1210-1216.
  • 14. Stern PJ, Drury WJ. Complications of plate fixation of fore arm fractures. Clin Orthop Relat Res 1983 ; 175 : 25-29.
  • 15. Qidwai SA. Treatment of diaphyseal forearm fractures in children by intramedullary kirschner wire.J Trauma.2001;50(2):303-7.
  • 16. Vander Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Ped Orthop 1998;18:9–13.
  • 17. Yung SH, Lam CY, Choi KY, Ng KW, Maffulli N, Cheng JCY. Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children. J Bone Joint Surg 1998;80:91–4.
  • 18. Pugh DMW, Galpin RD, Carey TP. Intramedullary Steinmann pin fixation of forearm fractures in children: long-term results. Clin Orthop 2000;376:39–48.
  • 19. Street DM. Intramedullary forearm nailing. Clin Orthop 1986;212:219–30.
  • 20. Cullen M. C.,Roy D. R.,Giza E., Crawfort H. A. Complications of intramedullary fixation of pediatric forearm fractures. J Pediatric Orthop.1998;18:14–21.
  • 21. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Ped Orthop 1990;10:167–71
  • 22. Küçükkaya M, Kabukçuoğlu YS, Tezer M, Eren OT, Kuzgun Ü. Çocuk Önkol Diafiz Kırıklarının Açık Elastik İntramedüller Fiksasyon ile Tedavisi. Acta Orthopaedica et. Traumatologica Turcica. 1998;32:103–6.
  • 23. Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 1999;19:329–37.
  • 24. Cumming D, Mfula N, Jones JW. Pediatric forearm fractures : the increasing use of elastic stable intramedullary nails. Int Orthop 2008 ; 32 : 421-423.
  • 25. Kapoor V, Theruvil B, Edwards SE et al. Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children. Injury 2005 ; 36 : 1221-1225.
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Gökhan Meriç

Bülent Kişin This is me

Mehmet Gem This is me

İhsan Şentürk This is me

Ali Engin Uysal This is me

Publication Date August 30, 2012
Submission Date March 3, 2012
Published in Issue Year 2012 Volume: 1 Issue: 2

Cite

APA Meriç, G., Kişin, B., Gem, M., Şentürk, İ., et al. (2012). ÇOCUK ÖNKOL KIRIKLARININ CERRAHİ TEDAVİSİNDE KANAL-İÇİ ELASTİK ÇİVİLEME; 23 HASTANIN GERİYE DÖNÜK ANALİZİ. Balıkesir Sağlık Bilimleri Dergisi, 1(2), 43-48.

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