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Yang L, Wang S, Xu J, Deng C, Wang K, Li Q, Zhou H, Ruan H, Zhuang W. Clinical Outcomes of Minimally Invasive Fixation with Pre-Bent Elastic Stable Intramedullary Nails for the Treatment of Distal Radius Metaphyseal Diaphysis Junction Fractures in Children. Orthop Surg 2023; 15:3223-3230. [PMID: 37880202 PMCID: PMC10694001 DOI: 10.1111/os.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Although mini-plate fixation is an attractive treatment option for distal radius metaphyseal diaphysis junction (DRMDJ) fractures in children, the benefits of minimally invasive fixation (MIF) with pre-bent elastic stable intramedullary nails (MIF) remain underexplored. Therefore, this study aimed to evaluate the clinical efficacy of MIF administration in children with DRMDJ fractures. METHODS This retrospective study enrolled 40 patients with DRMDJ fractures who underwent MIF or mini-plate fixation from January 2016 to January 2021. Radiographic parameters, such as palmar inclination and ulnar deflection angle, were examined postoperatively to assess the anatomical reduction of the wrist joint. Clinical outcomes, including the range of wrist flexion and back extension, were examined to analyze the recovery of the wrist range of motion. Additionally, the Gartland-Werley scoring system was used to assess the recovery status of wrist function and healing condition. The student t-test and χ2 test were used to compare differences among groups. RESULTS All included patients successfully underwent the operation and were followed up for 12-24 months. Patients in the MIF group had a smaller surgical incision length (0.49 ± 0.06 cm) compared to those in the mini-plate fixation group (4.41 ± 0.73 cm) (t = 22.438, p = 0.000). Palmar inclination and ulnar deflection were within the normal range in patients of both groups, and the fractures were successfully anatomically reduced. Moreover, wrist flexion and back extension in the MIF group and mini-plate group were (72.50° ± 0.64° vs. 70.18° ± 0.56°) and (59.55° ± 1.75° vs. 60.04° ± 1.37°), and differences were statistically significant (t = 2.708, p = 0.010 and t = 0.885, p = 0.382, respectively). Furthermore, MIF treatment resulted in a higher proportion of excellent Gartland-Werley scores (94.44%) than mini-plate fixation (86.36%) (p = 0.390). In addition, one case in the mini-plate fixation group experienced re-fracture following the removal of the internal fixation, and the fracture healed after reduction and cast fixation. All patients achieved satisfactory bone healing without other complications. CONCLUSION Compared with mini-plate fixation, MIF has the advantages of small incision length, superior range of motion of thr wrist joint, and better maintenance of the physiological radian, providing a promising approach for clinical and surgical treatment of DRMDJ fractures.
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Affiliation(s)
- Limeng Yang
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
| | - Shuqin Wang
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
| | - Jindi Xu
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
| | - Changzong Deng
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Kai Wang
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Qing Li
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
| | - Hua Zhou
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
| | - Hongfeng Ruan
- Institute of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Wei Zhuang
- Research Institute of OrthopaedicsThe Affiliated JiangNan Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- Hangzhou Xiaoshan Hospital of Traditional Chinese MedicineHangzhouChina
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Liebs TR, Lorance A, Berger SM, Kaiser N, Ziebarth K. Health-Related Quality of Life after Fractures of the Distal Forearm in Children and Adolescents—Results from a Center in Switzerland in 432 Patients. CHILDREN 2022; 9:children9101487. [PMID: 36291423 PMCID: PMC9601170 DOI: 10.3390/children9101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: We aimed to evaluate the health-related quality of life (HRQoL) in children with fractures of the distal forearm and to assess if HRQoL was associated with fracture classification; (2) Methods: We followed up on 432 patients (185 girls, 247 boys) who sustained a fracture of the distal radius or forearm from 1/2007 to 6/2007, 1/2014 to 6/2014, and 11/2016 to 10/2017. Patients filled in the Quick-DASH (primary outcome) and the Peds-QL; (3) Results: The radius was fractured in 429 and the ulna in 175 cases. The most frequent injury of the radius was a buckle fracture (51%, mean age 8.5 years), followed by a complete metaphyseal fracture (22%, 9.5 years), Salter-Harris-2 fracture (14%, 11.4 years), greenstick fracture (10%, 9.3 years), Salter-Harris-1 fracture (1%, 12.6 years), and other rare injuries. The most common treatment was closed reduction and an above-elbow cast in 138 cases (32%), followed by a cast without reduction (30%), splint (28%), and K-wire fixation and cast (9%). Definite treatment was performed initially in 95.8%, a new cast or cast wedging was performed in 1.6%, and revision surgery was performed in 2.5%. There were no open reductions and no plate fixations. After a mean follow-up of 4.2 years, patients with buckle fractures had a mean Quick-DASH of 3.3 (scale of 0–100) (complete fracture: 1.5; greenstick: 1.5; SH-1: 0.9; SH-2: 4.1; others: 0.9). The mean function score of the PedsQL ranged from 93.0 for SH-2 fractures to 97.9 for complete fractures; (4) Conclusions: In this cohort of 432 children with fractures of the distal forearm, there was equally good mean mid- and long-term HRQoL when assessed by the Quick-DASH and the PedsQL. There was a trend for children with complete metaphyseal fractures reporting better HRQoL than patients with buckle fractures or patients with Salter-Harris II fractures, however, these differences were not statistically significant nor clinically relevant.
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Perhomaa M, Kyrö A, Niinimäki J, Sinikumpu JJ. Retrograde intramedullary nailing of the radius in children: A pilot magnetic resonance imaging study of soft-tissue findings. J Child Orthop 2022; 16:269-275. [PMID: 35992516 PMCID: PMC9382708 DOI: 10.1177/18632521221114553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/02/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Unstable forearm shaft fractures in children are preferably treated surgically using elastic stable intramedullary nails. The radius is nailed retrograde from the distal metaphysis. There is a risk of surgery-related soft-tissue complications during the operation. Close evaluation of occult surgery-related soft-tissue lesions has not been possible previously, due to the titanium alloy hardware used in the process. The aim of the present study was to evaluate the potential findings in the surrounding soft tissues after intramedullary nailing of the radius, by using magnetic resonance imaging. METHODS The study population comprised 15 pediatric patients with forearm shaft fractures treated by polylactide-co-glycolide biodegradable intramedullary nails and postoperatively evaluated via magnetic resonance imaging. The main outcome was signal abnormality in any tendon at the entry point postoperatively. Secondarily, other changes in the soft tissues related to nailing were determined. Furthermore, the precise location of the entry point and the anatomic characteristics of the soft-tissue tunnel were described. RESULTS In total, 5 of 15 patients (33.3%) had transient signal pathology in a tendon postoperatively. Edema around the superficial radial nerve was detected in 13 of 15 patients (86.7%). The most common surgical approach was between the extensor pollicis brevis and the extensor carpi radialis longus tendons, which was applied in 10 of 15 patients (66.7%). CONCLUSIONS One in three patients exhibited transient and occult surgery-related intraparenchymal signal pathology in a tendon, after forearm intramedullary nailing. Caution with surgical prepare of the soft-tissue cleavage is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marja Perhomaa
- Oulu Childhood Fracture and Sports
Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children
and Adolescents, PEDEGO Research Group, Medical Research Center (MRC) Oulu, Oulu
University Hospital and Oulu University, Oulu, Finland,Department of Pediatric Radiology,
Medical Imaging, Physics and Technology (MIPT), Oulu University Hospital and Oulu
University, Oulu, Finland,Marja Perhomaa, Department of Pediatric
Radiology, Medical Imaging, Physics and Technology (MIPT), Oulu University
Hospital and Oulu University, PL 50, FIN-90029 OYS Oulu, Finland. Emails:
;
| | - Antti Kyrö
- Department of Children, Pediatric
Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jaakko Niinimäki
- Department of Pediatric Radiology,
Medical Imaging, Physics and Technology (MIPT), Oulu University Hospital and Oulu
University, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Oulu Childhood Fracture and Sports
Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children
and Adolescents, PEDEGO Research Group, Medical Research Center (MRC) Oulu, Oulu
University Hospital and Oulu University, Oulu, Finland
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Alberghina F, Andreacchio A, Pavone V, Mansour M, Dimeglio A, Canavese F. Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture. J Pediatr Orthop B 2022; 31:260-269. [PMID: 34406161 DOI: 10.1097/bpb.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.
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Affiliation(s)
- Flavia Alberghina
- Pediatric Orthopedic Department, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, 'Vittore Buzzi' Children's Hospital, Milano
| | - Vito Pavone
- Department of General Surgery, Section of Orthopedics and Traumatology, A.O.U. Policlinico 'Rodolico - San Marco', University of Catania, Catania, Italy
| | - Mounira Mansour
- Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand
| | - Alain Dimeglio
- Pediatric Surgery Department, Clinique St. Roch, Montpellier
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France
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BIOMECHANICAL FEATURES OF SINGLE-BONE OSTEOSYNTHESIS OF DIAPHYSEAL FRACTURES IN CHILDREN BY THE TITANIUM ELASTIC NAILS. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-2-80-103-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Weinberg AM, Röder C. [6/m-Not quite yet well versed : Preparation for the medical specialist examination: part 66]. Unfallchirurg 2021; 124:184-189. [PMID: 33624182 PMCID: PMC8674177 DOI: 10.1007/s00113-021-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Annelie-Martina Weinberg
- Universitätsklinik für Orthopädie und Unfallchirurgie, MUG Graz, Auenbruggerplatz 5, 8034, Graz, Österreich.
- Abteilung für Orthopädie & Traumatologie, Landesklinikum Baden-Mödling, Standort Mödling, Sr. M. Restituta-Gasse 12, 2340, Mödling, Österreich.
| | - Christoph Röder
- Abteilung für Orthopädie & Traumatologie, Landesklinikum Baden-Mödling, Standort Mödling, Sr. M. Restituta-Gasse 12, 2340, Mödling, Österreich
- Donau-Universität Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Österreich
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ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment. J Hand Ther 2021; 36:74-84. [PMID: 34247881 DOI: 10.1016/j.jht.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/23/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy. PURPOSE To determine the desired treatment outcomes of children with acquired upper extremity impairments. STUDY DESIGN Descriptive case series METHODS: Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes. RESULTS Following consensus, two independent raters linked 894 meaningful concepts to the study population's 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population's top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength. CONCLUSION The study population's top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population.
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Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children's Forearm Shaft Fractures with at Least Four Years of Follow-Up. J Clin Med 2021; 10:jcm10050995. [PMID: 33801217 PMCID: PMC7957875 DOI: 10.3390/jcm10050995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.
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Gallardo-Molina N. Letter to the Editor about the article: Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children. Rev Bras Ortop 2020; 55:808. [PMID: 33364665 PMCID: PMC7748932 DOI: 10.1055/s-0040-1709735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Acharya BM, Devkota P, Thakur AK, Gyawali B. Resposta à carta ao editor referente ao artigo: Fixaçço intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças. Rev Bras Ortop 2020; 55:809. [PMID: 33364666 PMCID: PMC7748943 DOI: 10.1055/s-0040-1712140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Balakrishnan M. Acharya
- Departamento de Ortopedia e Cirurgia de Trauma, Academia Patan de Ciências da Saúde, Hospital Patan, Lalitpur, Nepal
| | - Pramod Devkota
- Departamento de Ortopedia e Cirurgia de Trauma, Academia Patan de Ciências da Saúde, Hospital Patan, Lalitpur, Nepal
| | - Abhishek K. Thakur
- Departamento de Ortopedia e Cirurgia de Trauma, Academia Patan de Ciências da Saúde, Hospital Patan, Lalitpur, Nepal
| | - Bidur Gyawali
- Departamento de Ortopedia e Cirurgia de Trauma, Academia Patan de Ciências da Saúde, Hospital Patan, Lalitpur, Nepal
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Pogorelić Z, Gulin M, Jukić M, Biliškov AN, Furlan D. Elastic stable intramedullary nailing for treatment of pediatric forearm fractures: A 15-year single centre retrospective study of 173 cases. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:378-384. [PMID: 32442119 DOI: 10.5152/j.aott.2020.19128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for forearm fracture. METHODS The study included 173 patients (126 men and 47 women; median age: 11 years (range: 3-17 years) treated with ESIN for forearm fracture between May 2002 and May 2018. Immobilization was not performed after the surgery. The median follow-up was 68 months (range: 3-161 months). The etiology, healing time, and complications were recorded. RESULTS All patients achieved complete radiographic healing at a median of 6.8 weeks (range: 4-11 weeks). The most common injuries were sport related (n=65) and by falling from standing height (n=57), followed by injuries from bicycle riding, motorbike accidents, road traffic accidents, and fights. Fifteen (8.76%) postoperative complications were recorded: eight entry-site skin irritations, two cases of skin infection, two refractures, and one case each of nail migration, injury of ulnar nerve, and pseudoarthrosis. All complications, except cases of refractures and pseudoarthrosis, were treated conservatively, with no long-term consequences for the patients. Patients with refractures and pseudoarthrosis were reoperated, and complete function of the extremities was fully restored. CONCLUSION ESIN for treatment of forearm fractures in children shows good functional and cosmetic results. This is a minimally invasive, cast-free, simple, and reproducible technique, with a low complication rate. Owing to these excellent objective and subjective results, surgical stabilization of the forearm fracture using ESIN is recommended in children and adolescents. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia;Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Marko Gulin
- Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Ana Nevešćanin Biliškov
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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Adam O, David VL, Horhat FG, Boia ES. Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children. ACTA ACUST UNITED AC 2020; 56:medicina56020079. [PMID: 32075219 PMCID: PMC7074387 DOI: 10.3390/medicina56020079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.
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Affiliation(s)
- Ovidiu Adam
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
| | - Vlad Laurentiu David
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
- Correspondence: (V.L.D.); (F.G.H.)
| | - Florin George Horhat
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq No 2, 300041 Timisoara, Romania
- Correspondence: (V.L.D.); (F.G.H.)
| | - Eugen Sorin Boia
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
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