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Treatment of paediatric unstable displaced distal radius fractures using Kapandji technique: a case series

  • Silvia ValisenaEmail author
  • Jorge Gabriel Gonzalez
  • Natalia Maria Voumard
  • Flurim Hamitaga
  • Bernhard Dimitris Ciritsis
  • Mario Mendoza Sagaon
  • Vincenzo De Rosa
Original Article • WRIST - PAEDIATRICS
  • 92 Downloads

Abstract

Background

The technique of intra-focal pinning described by Kapandji is seldom used in paediatric patients. We present our series of paediatric patients treated with Kapandji technique for unstable displaced distal radius fractures.

Methods

We retrospectively reviewed medical records and radiographs of a consecutive series of 56 paediatric patients who underwent closed reduction and fixation with Kapandji technique for unstable displaced metaphyseal and Salter Harris 2 distal radius fractures, from 2008 to March 2018. One or two percutaneous K-wires were inserted intra-focally without crossing the physis to lever out, reduce and stabilize the distal fragment. The arm was immobilized with an above-elbow cast, and radiographic controls were scheduled at 1, 4, 8 weeks, at least.

Results

The mean age at the time of the trauma was 10.5 years. The K-wires were removed at a mean of 6.4 post-operative weeks. An above-elbow cast was used for the first 4 weeks, afterwards a below-elbow cast for 2 weeks and a short-arm brace until the full recovery of motion. The mean follow-up was 18 months (range 1.5–108 months). No pin-related complications were found. All fractures showed good healing, and the full function of the wrist was achieved in every case.

Conclusion

Kapandji pinning is a reliable technique in paediatric patients with unstable displaced distal radius fractures. It shows a lower complication rate compared to other techniques. For these reasons, we suggest implementing its use in clinical practice.

Keywords

Paediatric Distal radius Fracture Kapandji 

Notes

Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest.

References

  1. 1.
    Cheng JC, Shen WY (1993) Limb fracture pattern in different pediatric age groups: a study of 3350 children. J Orthop Trauma 7(1):15–22CrossRefGoogle Scholar
  2. 2.
    Wendling-Keim DS, Wieser B, Dietz H-G (1993) Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children? Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc 41(4):421–428CrossRefGoogle Scholar
  3. 3.
    Waters PM, Mih AD (2006) Fractures of the distal radius and ulna. In: Beaty JH, Kasser JR (eds) Rockwood and Wilkins’ fractures in children, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 337–398Google Scholar
  4. 4.
    Bae DS (2008) Pediatric distal radius and forearm fractures. J Hand Surg Am 33(10):1911–1923CrossRefGoogle Scholar
  5. 5.
    Alemdaroğlu KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D (2008) Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am 90(6):1224–1230CrossRefGoogle Scholar
  6. 6.
    Sankar WN, Beck NA, Brewer JM, Baldwin KD, Pretell JA (2011) Isolated distal radial metaphyseal fractures with an intact ulna: risk factors for loss of reduction. J Child Orthop 5(6):459–464CrossRefGoogle Scholar
  7. 7.
    Ramoutar DN, Shivji FS, Rodrigues JN, Hunter JB (2015) The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation: a review of 248 cases. Eur J Orthop Surg Traumatol 25(3):471–476CrossRefGoogle Scholar
  8. 8.
    Jung HJ, Jung YB, Jang EC, Song K-S, Kang KS, Kang SY, Lee J-S (2007) Transradioulnar single Kirschner-wire fixation versus conventional Kirschner-wire fixation for unstable fractures of both of the distal forearm bones in children. J Pediatr Orthop 27(8):867–872CrossRefGoogle Scholar
  9. 9.
    McLauchlan GJ, Cowan B, Annan IH, Robb JE (2002) Management of completely displaced metaphyseal fractures of the distal radius in children: a prospective, randomised controlled trial. J Bone Joint Surg Br 84:413–417CrossRefGoogle Scholar
  10. 10.
    Choi KY, Chan WS, Lam TP, Cheng JCY (1995) Percutaneous kirschner-wire pinning for severely displaced distal radial fractures in children: a report of 157 cases. J Bone joint Surg Ser B 77(5):797–801CrossRefGoogle Scholar
  11. 11.
    Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM (2005) Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop 25(4):490–494CrossRefGoogle Scholar
  12. 12.
    Huang W, Zhang X, Zhu H, Wang X, Sun J, Shao X (2016) A percutaneous reduction technique for irreducible and difficult variant of paediatric distal radius and ulna fractures. Injury 47(6):1229–1235CrossRefGoogle Scholar
  13. 13.
    Satish BRJ, Vinodkumar M, Suresh M, Seetharam PY, Jaikumar K (2014) Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures. Orthopedics 37(9):e810–e816CrossRefGoogle Scholar
  14. 14.
    Parikh SN, Jain VV, Youngquist J (2013) Intrafocal pinning for distal radius metaphyseal fractures in children. Orthopedics 36(6):783–788CrossRefGoogle Scholar
  15. 15.
    Guichet JM, Moller CC, Dautel G, Lascombes P (1997) A modified Kapandji procedure for Smith’s fracture in children. J Bone Joint Surg Br 79:734–737CrossRefGoogle Scholar
  16. 16.
    Rubin G, Orbach H, Chezar A, Rozen N (2017) Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique. Arch Orthop Trauma Surg 137(1):49–54CrossRefGoogle Scholar
  17. 17.
    Cai H, Wang Z, Cai H (2014) Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg 99(3):269–275CrossRefGoogle Scholar
  18. 18.
    Joulié S, Laville JM, 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(3):330–334CrossRefGoogle Scholar
  19. 19.
    Colaris JW, Allema JH, Biter LU, de Vries MR, van de Ven CP, Bloem RF, Kerver AJH, Reijman M, Verhaar JAN (2013) Re-displacement of stable distal both-bone forearm fractures in children: a randomised controlled multicentre trial. Injury 44(4):498–503CrossRefGoogle Scholar
  20. 20.
    Sano K, Hashimoto T, Kimura K, Ozeki S (2013) Percutaneous flexible double pinning (Py–Desmanet’s procedure) for pediatric distal radius fractures. Hand 8(4):392–396CrossRefGoogle Scholar
  21. 21.
    Kamiloski M, Todorovik L, Memeti S, Jovcevski L, Shuperliska S, Aleksovski Z (2018) The Kapandji technique of closed reduction using sommer—pins in the treatment of completely dislocated fractures of the distal radius in children. Open Access Maced J Med Sci 6(2):330–335CrossRefGoogle Scholar
  22. 22.
    Kapandji A (1976) L’ostéosynthèse par double embrochage intra-focal. Traitement fonctionnel des fractures non articulaires de l’extrémité inférieure du radius. Ann Chir 30(11–12):903–908Google Scholar
  23. 23.
    Kapandji A (1987) L’embrochage intra-focal des fractures de l’extrémité inférieure du radius dix ans après. Ann Chir Main 6(1):57–63CrossRefGoogle Scholar
  24. 24.
    Lim YJ, Lam KS, Lee EH (2007) Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement? J Pediatr Orthop 27(5):540–546CrossRefGoogle Scholar
  25. 25.
    Kelly BA, Miller P, Shore BJ, Waters PM, Bae DS (2014) Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications. J Pediatr Orthop 34(8):749–755CrossRefGoogle Scholar
  26. 26.
    Abzug JM, Little K, Kozin SH (2014) Physeal arrest of the distal radius. J Am Acad Orthop Surg 22(6):381–389CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Service of Traumatology, Orthopaedics and Hand SurgeryRegional Hospital of BellinzonaBellinzonaSwitzerland
  2. 2.Service of Paediatric Surgery and Paediatric OrthopaedicsRegional Hospital of BellinzonaBellinzonaSwitzerland

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