Timing of osteosynthesis of fractures in children changes the outcome

Therapeutic approaches of diametaphyseal radius fractures in children

BACKGROUND

There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations.

METHODS

This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW).

RESULTS

During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified.

CONCLUSIONS

The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.

Effect of Multichannel Convolutional Neural Network-Based Model on the Repair and Aesthetic Effect of Eye Plastic Surgery Patients

Objective

This study is aimed at exploring the impact of eye model based on multichannel convolutional neural network (CNN) on eye plastic surgery and aesthetic effect, thus formulating methods to improve the effect of eye plastic surgery.

Methods

A total of 64 patients who underwent pouch plastic surgery from January 2020 to March 2021 were selected as the research objects and were divided into observation group and control group by random number table method. The subjects in the observation group were evaluated by multichannel CNN-based eye model and doctors' experience, while those in the control group were evaluated by doctors' experience only, with 32 cases in both groups. Blepharoplasty, lower eyelid skin wrinkles, skin luster, and aesthetic scores were compared between the two groups.

Results

The similarity between the multichannel CNN model detected shape and the actual eye shape (98.78%) was considerably higher than that of the CNN model detected shape (78.65%) (P < 0.05). After treatment, the indexes of pouch degree, lower eyelid skin wrinkle, eyelid lacrimal sulcus, skin gloss, and aesthetic score in the observation group were better than those in the control group (P < 0.05). The incidence of complications in the observation group (13%) was considerably lower than that in the control group (28%) (P < 0.05).

Conclusion

The eye model based on the multichannel CNN model was helpful to improve the surgical repair and aesthetic effect of patients and can improve the occurrence of postoperative complications.