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Dorsal or Lateral Approach for Intramedullary Nailing Using Kirschner Wire in Pediatric Radius Diaphyseal Fractures: Does it really matter?

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Abstract

Background

Intramedullary nailing is the most preferred fixation method for diaphyseal radius and ulna fractures in the young age group. The aim of this study was to compare the dorsal and lateral entry points in the context of entry site-related complications, fracture union and functional results.

Methods

This retrospective comparative study included pediatric patients who underwent surgery for isolated diaphyseal radius or both bone forearm fractures with intramedullary nailing using Kirschner wire between January 2013 and January 2019. K-wire was introduced from the distal radius through dorsal entry (Group A) in 19 patients and lateral entry (Group B) in 18 patients. The mean follow-up was 37 months. Complications were noted and functional outcomes were evaluated according to the CHOP criteria.

Results

All fractures were healed. The functional results were determined to be excellent for 30, fair for 4, and poor for 3 patients. The overall complication rate was 18.9%, including distal radius fracture, mild pain in the wrist, and minor loss in ROM. No statistically significant differences were determined between the groups in respect of functional results and complication rates.

Conclusion

Good functional results and similar complication rates can be obtained with both dorsal and lateral entry approaches. Stainless steel K-wire is an inexpensive intramedullary fixation implant option, which provides strong stabilization. Distal radius fracture is a newly reported complication for forearm intramedullary nailing. Leaving the implant out of the skin seems safe with the benefit of avoiding a further surgical intervention to extract the implant.

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References

  1. Zionts, L. E., Zalavras, C. G., & Gerhardt, M. B. (2005). Closed treatment of displaced both-bone forearm fractures in older children and adolescents. Journal of Pediatric Orthopedics, 25, 507–512.

    Article  Google Scholar 

  2. Pace, J. L. (2016). Pediatric and adolescent forearm fractures: current controversies and treatment recommendations. Journal of American Academy of Orthopaedic Surgeons, 24(11), 780–788. (Review).

    Article  Google Scholar 

  3. Mehlman, C. T., & Wall, E. J. (2015). Diaphyseal radius and ulna fractures. In J. M. Flynn, D. L. Skaggs, & P. M. Waters (Eds.), Rockwood and Wilkins’ fractures in children (8th ed., pp. 413–472). Philadelphia: Wolters Kluwer.

    Google Scholar 

  4. Murphy, H. A., Jain, V. V., Parikh, S. N., Wall, E. J., Cornwall, R., & Mehlman, C. T. (2019). Extensor tendon injury associated with dorsal entry flexible nailing of radial shaft fractures in children: a report of 5 new cases and review of the literature. Journal of Pediatric Orthopedics, 39(4), 163–168. https://doi.org/10.1097/BPO.0000000000000897.

    Article  PubMed  Google Scholar 

  5. Nørgaard, S. L., Riber, S. S., Danielsson, F. B., Pedersen, N. W., & Viberg, B. (2018). Surgical approach for elastic stable intramedullary nail in pediatric radius shaft fracture: a systematic review. Journal of Pediatric Orthopedics. Part B, 27(4), 309–314. https://doi.org/10.1097/BPB.0000000000000458.Review.

    Article  PubMed  Google Scholar 

  6. Fernandez, F. F., Langendörfer, M., Wirth, T., & Eberhardt, O. (2010). Failures and complications in intramedullary nailing of children’s forearm fractures. Journal of Children’s Orthopaedics, 4(2), 159–167. https://doi.org/10.1007/s11832-010-0245-y (Epub 2010 Feb 24).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Smith, V. A., Goodman, H. J., Strongwater, A., & Smith, B. (2005). Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. Journal of Pediatric Orthopedics, 25(3), 309–313.

    Article  Google Scholar 

  8. Flynn, J. M., Jones, K. J., Garner, M. R., & Goebel, J. (2010). Eleven years experience in the operative management of pediatric forearm fractures. Journal of Pediatric Orthopedics, 30(4), 313–319. https://doi.org/10.1097/BPO.0b013e3181d98f2c.

    Article  PubMed  Google Scholar 

  9. Wall, L. B. (2016). Staying out of trouble performing intramedullary nailing of forearm fractures. Journal of Pediatric Orthopedics, 36(Suppl 1), S71–S73. https://doi.org/10.1097/BPO.0000000000000760.Review.

    Article  PubMed  Google Scholar 

  10. Schmittenbecher, P. P., Fitze, G., Gödeke, J., Kraus, R., & Schneidmüller, D. (2008). Delayed healing of forearm shaft fractures in children after intramedullary nailing. Journal of Pediatric Orthopaedics, 28(3), 303–306. https://doi.org/10.1097/BPO.0b013e3181684cd6.

    Article  PubMed  Google Scholar 

  11. Şahin, N., Akalın, Y., Türker, O., & Özkaya, G. (2017). ESIN and K-wire fixation have similar results in pediatric both-bone diaphyseal forearm fractures. Ulus Travma Acil Cerrahi Derg., 23(5), 415–420. https://doi.org/10.5505/tjtes.2017.85891.

    Article  PubMed  Google Scholar 

  12. Heare, A., Goral, D., Belton, M., Beebe, C., Trizno, A., & Stoneback, J. (2017). Intramedullary implant choice and cost in the treatment of pediatric diaphyseal forearm fractures. Journal of Orthopaedic Trauma, 31(10), e334–e338. https://doi.org/10.1097/BOT.0000000000000925.

    Article  PubMed  Google Scholar 

  13. Battle, J., Carmichael, K. D., & Morris, R. P. (2006). Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures. Journal of Pediatric Orthopedics. Part B, 15(5), 370–375.

    Article  Google Scholar 

  14. Hunter, J. B. (2005). The principles of elastic stable intramedullary nailing in children. Injury, 36, 20–24. https://doi.org/10.1016/j.injury.2004.12.009.

    Article  Google Scholar 

  15. Daruwalla, J. S. (1979). A study of radioulnar movements following fractures of the forearm in children. Clinical Orthopaedics and Related Research, 139, 114–120.

    Google Scholar 

  16. Lee, A. K., Beck, J. D., Mirenda, W. M., & Klena, J. C. (2016). Incidence and risk factors for extensor pollicis longus rupture in elastic stable intramedullary nailing of pediatric forearm shaft fractures. Journal of Pediatric Orthopedics, 36(8), 810–815.

    Article  Google Scholar 

  17. Parikh, S. N., Jain, V. V., Denning, J., Tamai, J., Mehlman, C. T., McCarthy, J. J., et al. (2012). Complications of elastic stable intramedullary nailing in pediatric fracture management: AAOS exhibit selection. Journal of Bone and Joint Surgery. American Volume, 94(24), e184.

    Article  Google Scholar 

  18. Cumming, D., Mfula, N., & Jones, J. W. M. (2008). Paediatric forearm fractures: The increasing use of elastic stable intra-medullary nails. International Orthopaedics, 32, 421–423.

    Article  CAS  Google Scholar 

  19. Joulie, S., Laville, J. M., & Salmeron, F. (2011). Posteromedial elastic stable intra-medullary nailing (ESIN) in volarly displaced metaphyso-diaphyseal distal radius fractures in child. Orthop Traumatol Surg Res, 97, 330–334.

    Article  CAS  Google Scholar 

  20. Dinçer, R., Köse, A., Topal, M., Öztürk, İA., & Engin, M. Ç. (2020). Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? Journal of Pediatric Orthopedics. Part B, 29(2), 158–163. https://doi.org/10.1097/BPB.0000000000000635.

    Article  PubMed  Google Scholar 

  21. Kelly, B. A., Miller, P., Shore, B. J., Waters, P. M., & Bae, D. S. (2014). Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications. Journal of Pediatric Orthopedics, 34(8), 749–755. https://doi.org/10.1097/BPO.0000000000000210.

    Article  PubMed  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey

    Ahmet Hamdi Akgülle, Mehmet Deniz Kesimer, Osman Mert Topkar & Evrim Şirin

  2. Department of Orthopaedics and Traumatology, Dr. Lütfi Kırdar Kartal City Hospital, Istanbul, Turkey

    Tolga Onay

  3. Selahattin Eyyubi State Hospital, Diyarbakir, Turkey

    Servet İğrek

Authors
  1. Ahmet Hamdi Akgülle
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  2. Tolga Onay
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  3. Servet İğrek
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  4. Mehmet Deniz Kesimer
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  5. Osman Mert Topkar
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  6. Evrim Şirin
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Correspondence to Tolga Onay.

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Akgülle, A.H., Onay, T., İğrek, S. et al. Dorsal or Lateral Approach for Intramedullary Nailing Using Kirschner Wire in Pediatric Radius Diaphyseal Fractures: Does it really matter?. JOIO 55 (Suppl 2), 323–329 (2021). https://doi.org/10.1007/s43465-021-00384-8

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  • DOI: https://doi.org/10.1007/s43465-021-00384-8

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