Abstract
Introduction
Closed reduction and internal fixation are a widespread surgical treatment for pediatrics displaced extraphyseal distal radius fractures. Post-surgical cast immobilization is usually needed. Epibloc system (ES) is a device used to fix Colles fractures in adults, not requiring post-surgical immobilization. The aim of the study is to investigate the effectiveness of ES in a pediatric population suffering from displaced extraphyseal distal radius fractures.
Methods
We retrospectively analyzed 52 patients (age 8–12 years) who underwent CRIF. Patients were divided into two groups. Group A (25 patients): ES osteosynthesis. Group B (27 patients): K-wires and short arm cast osteosynthesis. The primary outcome is the maintenance of reduction in radiographs (displacement on frontal and lateral view). The secondary outcome is the reaching of the complete active range of motion recovery (compared with the contralateral side) and the time needed to obtain it. The need of further additional treatment (physiotherapy) and the presence of complication were also assessed.
Results
Reduction was equally maintained in both groups (p > 0.05). Physiotherapy was mandatory for 11 patients in group B; only for 3 patients in group A, the difference was statistically significant (p = 0.03) according to Fisher test. Otherwise, the difference was not statistically significant regarding complications. (p > 0.05). At the last follow-up, complete functional recovery was reached in all patients.
Conclusions
Functional recovery is faster, and postoperative physiotherapy is rarely required with ES. This device allows us to go beyond the traditional concept of mandatory postoperative immobilization after pediatric wrist fractures surgery.
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References
Cheng JC, Shen WY (1993) Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 7:15–22. https://doi.org/10.1097/00005131-199302000-00004
Stein H, Volpin G, Horesh Z, Hoerer D (1990) Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases. Acta Orthop Scand 61:453–456. https://doi.org/10.3109/17453679008993561
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 25:471–476. https://doi.org/10.1007/s00590-014-1553-6
De Vitis R, Passiatore M, Perna A et al (2020) Modified Matti–Russe technique using a “butterfly bone graft” for treatment of scaphoid non-union. J Orthop 19:63–66. https://doi.org/10.1016/j.jor.2019.11.030
van Egmond PW, Schipper IB, van Luijt PA (2012) Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated. Eur J Orthop Surg Traumatol 22:201–207. https://doi.org/10.1007/s00590-011-0826-6
Varga M, Jozsa G, Fadgyas B et al (2017) Short, double elastic nailing of severely displaced distal pediatric radial fractures: a new method for stable fixation. Med (Baltim) 96:e6532. https://doi.org/10.1097/MD.0000000000006532
Valisena S, Gonzalez JG, Voumard NM et al (2019) Treatment of paediatric unstable displaced distal radius fractures using Kapandji technique: a case series. Eur J Orthop Surg Traumatol 29:413–420. https://doi.org/10.1007/s00590-018-2297-5
Adrian M, Wachtlin D, Kronfeld K et al (2015) A comparison of intervention and conservative treatment for angulated fractures of the distal forearm in children (AFIC): study protocol for a randomized controlled trial. Trials 16:437. https://doi.org/10.1186/s13063-015-0912-x
Solarino G, Vicenti G, Abate A et al (2016) Volar locking plate vs epibloc system for distal radius fractures in the elderly. Injury 47(Suppl 4):S84–S90. https://doi.org/10.1016/j.injury.2016.07.056
Catalano F, Poggi D, Massarella M et al (2004) Revisione critica di 1247 fratture metaepifisarie dell’arto superiore trattate con il sistema Epibloc®: studio multicentrico. Riv Chir Mano 41:89–104
Geraci A, Sanfilippo A, D’Arienzo M (2011) The treatment of wrist fractures with Epibloc system. Ortop Traumatol Rehabil 13:1–7. https://doi.org/10.5604/15093492.933787
Altissimi M, Nienstedt F (2007) Fratture del radio distale. in: Trattato di chirurgia della mano. Verduci, pp 70–103
Tangari M, Minniti De Simeonibus A (2007) About a new system of percutaneous synthesis: “the Delta synthesis”. G Ital di Ortop e Traumatol 33:60–65
Tangari M (2002) Personal technique for the Kirschner wires utilization in traumatology. G Ital di Ortop e Traumatol 28:2–10
Satish BRJ, Vinodkumar M, Suresh M et al (2014) Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures. Orthopedics 37:e810–e816. https://doi.org/10.3928/01477447-20140825-58
Joeris A, Lutz N, Blumenthal A et al (2017) The AO pediatric comprehensive classification of long bone fractures (PCCF). Acta Orthop 88:123–128. https://doi.org/10.1080/17453674.2016.1258532
De Pellegrin M, Fracassetti D, Moharamzadeh D et al (2018) Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. Lit Rev Inj 49(Suppl 3):S37–S42. https://doi.org/10.1016/j.injury.2018.09.046
Catena N, Calevo MG, Fracassetti D et al (2019) Risk of ulnar nerve injury during cross-pinning in supine and prone position for supracondylar humeral fractures in children: a recent literature review. Eur J Orthop Surg Traumatol 29:1169–1175. https://doi.org/10.1007/s00590-019-02444-0
Noonan KJ, Price CT (1998) Forearm and distal radius fractures in children. J Am Acad Orthop Surg 6:146–156. https://doi.org/10.5435/00124635-199805000-00002
Van der Reis WL, Otsuka NY, Moroz P, Mah J (1998) Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop 18:9–13
De Vitis R, Passiatore M, Cilli V et al (2020) Intramedullary nailing for treatment of forearm non-union: Is it useful?: a case series. J Orthop 20:97–104. https://doi.org/10.1016/j.jor.2020.01.011
Ricciardi L, Sturiale CL, Pucci R et al (2019) Patient-oriented aesthetic outcome after lumbar spine surgery: a 1-year follow-up prospective observational study comparing minimally invasive and standard open procedures. World Neurosurg 122:e1041–e1046. https://doi.org/10.1016/j.wneu.2018.10.208
Tamburrelli FC, Perna A, Proietti L et al (2019) The feasibility of long-segment fluoroscopy-guided percutaneous thoracic spine pedicle screw fixation, and the outcome at two-year follow-up. Malays Orthop J 13:39–44. https://doi.org/10.5704/MOJ.1911.007
Wendling-Keim DS, Wieser B, Dietz H-G (2015) Closed reduction and immobilization of displaced distal radial fractures. method of choice for the treatment of children? Eur J Trauma Emerg Surg 41:421–428. https://doi.org/10.1007/s00068-014-0483-7
Edgerton VR, Roy RR, Allen DL, Monti RJ (2002) Adaptations in skeletal muscle disuse or decreased-use atrophy. Am J Phys Med Rehabil 81:S127–S147. https://doi.org/10.1097/00002060-200211001-00014
Madhuri V, Dutt V, Gahukamble AD, Tharyan P (2013) Conservative interventions for treating diaphyseal fractures of the forearm bones in children. Cochrane database Syst Rev. https://doi.org/10.1002/14651858.CD008775.pub2
Gong HS, Lee JO, Huh JK et al (2011) Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation. Injury 42:1266–1270. https://doi.org/10.1016/j.injury.2011.01.005
Mohamed O, Bousbaa H, Bennani M et al (2018) Treatment of humerus diaphyseal fractures using Hackethal’s retrograde centro-medullary bundle nailing: about 54 cases. Pan Afr Med J 30:38. https://doi.org/10.11604/pamj.2018.30.38.14589
Akar D, Koroglu C, Erkus S et al (2018) Conservative follow-up of severely displaced distal radial metaphyseal fractures in children. Cureus 10:e3259. https://doi.org/10.7759/cureus.3259
Heare A, Goral D, Belton M et al (2017) Intramedullary implant choice and cost in the treatment of pediatric diaphyseal forearm fractures. J Orthop Trauma 31:e334–e338. https://doi.org/10.1097/BOT.0000000000000925
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Passiatore, M., De Vitis, R., Perna, A. et al. Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K-wire pinning. Eur J Orthop Surg Traumatol 30, 1243–1250 (2020). https://doi.org/10.1007/s00590-020-02698-z
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DOI: https://doi.org/10.1007/s00590-020-02698-z