Forearm diaphyseal fractures in children: Intramedullary Kirschner's wire fixation treatment

• Published in: Revista española de cirugía ortopédica y traumatología 2018-01, Vol.62 (1), p.71-79
• Main Authors: Mahecha-Toro, M., Vergara-Amador, E., González Ramírez, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Antebrazo; Bone Wires; Child; Child, Preschool; Diaphyses - diagnostic imaging; Diaphyses - injuries; Diaphyses - surgery; Female; Fijación intramedular de fracturas; Follow-Up Studies; Forearm; Fracturas del cúbito; Fracturas del radio; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Humans; Intramedullary fractures fixation; Male; Radiography; Radius fractures; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Retrospective Studies; Treatment Outcome; Ulna fractures; Ulna Fractures - diagnostic imaging; Ulna Fractures - surgery
• ISSN: 1988-8856; 1988-8856
• DOI: 10.1016/j.recote.2017.12.002

Diaphyseal fractures of the forearm comprise 6%–10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results. Las fracturas diafisarias del antebrazo constituyen el 6-10% de todas las fracturas en niños. El tratamiento depende de la edad y el tipo de desplazamiento y son válidos el manejo conservador y quirúrgico con fijación de clavos intramedulares entre otros. El objetivo es mostrar los resultados radiológicos y funcionales, y las complicaciones de la fijación intramedular con clavos de Kirschner en niños. Es una serie de casos retrospectiva descriptiva de pacientes operados con fijación intramedular de fracturas de antebrazo. Se correlacionan los resultados radiológicos y funcionales y las complicaciones. De 117 pacientes operados, 59 cumplían criterios de inclusión. La edad promedio fue 10 años. El 84,7% de ellos fueron hombres y el izquierdo el lado más afectado (62,7%). El 88,1% de ambos huesos estaban fracturados y 11 casos tenían fracturas abiertas. Se realizó reducción abierta en el 72,8% de los casos cuyas prin