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Hidajat NN, Magetsari RMSN, Prasetiyo GT, Respati DRP, Tjandra KC. Buried or exposed Kirschner wire for the management of hand and forearm fractures: A systematic review, meta-analysis, and meta-regression. PLoS One 2024; 19:e0296149. [PMID: 38748687 PMCID: PMC11095696 DOI: 10.1371/journal.pone.0296149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures. METHODS We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2). RESULTS A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. CONCLUSION Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
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Affiliation(s)
- Nucki Nursjamsi Hidajat
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | | | - Gregorius Thomas Prasetiyo
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Wangler S, Elias M, Schoepke L, Merky DN, Meier R, Vögelin E. Cat bite injuries to the hand and forearm: the impact of antibiotic treatment on microbiological findings and clinical outcome. Arch Orthop Trauma Surg 2024; 144:2443-2447. [PMID: 38546860 PMCID: PMC11093789 DOI: 10.1007/s00402-024-05277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/07/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Patients and physicians often underestimate cat bite injuries. The deep and narrow wound seals quickly and provides an environment for the inoculated saliva and bacteria. Interestingly, the literature reports no bacterial growth in the microbiological workup of wound swaps in up to 43%. The time between bite injury and the first clinical presentation, the start of antibiotic treatment and surgical debridement might affect these findings. Therefore, the current project examines if (1) these factors impact the outcome of microbiological results following cat bite injuries and (2) the detection of bacterial growth leads to higher complication rates, longer hospital stays, longer total treatment time, or higher total treatment costs. MATERIALS AND METHODS This single-center retrospective study analyzed data from 102 adult patients. All patients received antibiotic and surgical treatment following a cat bite injury. Microbiological samples were collected during surgery in all cases. The time from the bite incident to the first presentation, beginning of antibiotic administration, and surgical debridement was calculated. Demographic data, complication rate, length of hospital stay, total treatment time, and total treatment costs were recorded. (1) A generalized linear model was fitted using the microbiological outcome as the dependent variable. (2) Two groups (negative or positive microbiological results) were formed and statistically compared. RESULTS The median age was 50 (SD 16), and 72% were female. (1) The time from the bite incident to the first clinical presentation, antibiotic administration, or surgical treatment was not associated with the outcome of the microbiological result. (2) No significant differences were observed between the two groups. CONCLUSIONS Our data do not suggest that early antibiotic administration or delayed surgical treatment affects the outcome of the microbiological workup following cat bite injuries to the hand and forearm. The microbiological outcome did not affect the complication rate, treatment time, and total treatment costs.
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Affiliation(s)
- Sebastian Wangler
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Miriam Elias
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Linus Schoepke
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominique N Merky
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lari A, Hassan Y, Altammar A, Esmaeil A, Altammar A, Prada C, Jarragh A. Interlocking intramedullary nail for forearm diaphyseal fractures in adults-A systematic review and meta-analysis of outcomes and complications. J Orthop Traumatol 2024; 25:16. [PMID: 38615140 PMCID: PMC11016039 DOI: 10.1186/s10195-024-00761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. METHODS Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. RESULTS A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace-Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. CONCLUSIONS Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). LEVEL OF EVIDENCE III
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Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait.
| | - Yousef Hassan
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Abdulwahab Altammar
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Ali Esmaeil
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Abdulaziz Altammar
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Carlos Prada
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada
| | - Ali Jarragh
- Department of Orthopedic Surgery, Kuwait University, Kuwait City, Kuwait
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Stark D, Denzinger M, Ebert L, Brandl R, Knorr C. Therapeutic approaches of diametaphyseal radius fractures in children. Arch Orthop Trauma Surg 2024; 144:1179-1188. [PMID: 38231205 DOI: 10.1007/s00402-023-05118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/28/2023] [Indexed: 01/18/2024]
Abstract
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.
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Affiliation(s)
- D Stark
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany.
| | - M Denzinger
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - L Ebert
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - R Brandl
- Klinik für Radiologie, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
| | - C Knorr
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
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Ulus SA, Atiç R, Yiğit Ş, Akar MS, Dönmez S, Özkul E. Evaluation of surgical or conservative treatment of forearm fracture in pediatric floating elbow injuries. Eur Rev Med Pharmacol Sci 2024; 28:924-930. [PMID: 38375697 DOI: 10.26355/eurrev_202402_35329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Floating elbow, which refers to a humerus fracture in the supracondylar region and a forearm fracture, is a very unusual injury. The purpose of this study is to compare the clinical results of patients with "floating elbows" who underwent surgical therapy and who were given forearm immobilization with a splint as follow-up care. PATIENTS AND METHODS Fifteen patients who had been diagnosed with floating elbow owing to trauma were scanned retrospectively and followed up for at least a year. Eight individuals who suffered from broken forearms underwent surgical repair. After initial treatment, a lengthy arm splint was used to immobilize seven patients' arms. The modified Flynn criteria were used to analyze the data, and comparisons were made between the groups. RESULTS The median age and mean follow-up time for patients whose forearms were conservatively followed was 6.1 years and 13.8 months, respectively. The median age of the patients who underwent forearm surgery was 8.5 years, and the average follow-up was 14.2 months. Five of the seven patients whose forearms underwent conservative follow-up had outstanding clinical outcomes, while two had poor and moderate outcomes. Four individuals who got surgical treatment for their forearms had excellent and good clinical outcomes, while the other four had intermediate and poor outcomes. Between the two groups, there was no discernible difference (p = 0.60). CONCLUSIONS In the pediatric population with floating elbow injuries, using a cast for forearm fractures may not necessarily result in worse outcomes compared to surgical management.
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Affiliation(s)
- S A Ulus
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey.
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Bhardwaj P, Varadharajan V, Venkatramani H, Sabapathy SR. Options for Restoring Finger Extension in Mangled Forearm Injuries. J Hand Surg Asian Pac Vol 2024; 29:75-79. [PMID: 38299246 DOI: 10.1142/s2424835524710012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Restoration of finger extension in mutilating hand injuries is crucial for restoring prehension and independent use of the hand. Patients often express desire to restore finger extension once finger flexion is achieved. However, the extensive forearm injury precludes use of any of conventional donors like the wrist or finger flexors for transfer to restore finger extension. Two patients with sequelae of mangled forearm injuries, underwent biceps and long head of triceps transfer to the finger extensors to improve opening up of the fingers. We discuss the treatment considerations while planning these transfers and provide the technical details, rehabilitation and outcome of these patients. Both the patients expressed dramatic improvement of their hand function and were satisfied with the outcome. Biceps and long head of triceps could serve as an effective second-line donor for restoration of finger extension when the conventional donors are not available. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Praveen Bhardwaj
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Center and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - Vigneswaran Varadharajan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Center and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Center and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Center and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
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Abstract
The aim of this article is to review the evaluation and management of pediatric forearm malunions. Acceptable parameters for nonoperative management of pediatric forearm fractures are reviewed, followed by clinical and imaging workups of malunions and decision-making points for treatment. The landscape of available technology for planning and execution of corrective osteotomy is discussed. Several cases of pediatric forearm malunion are presented, along with surgical and functional outcomes. Recommendations are given regarding the authors' preferred approach for management of pediatric forearm malunions.
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Affiliation(s)
- Shea Ray
- Department of Orthopedic Surgery, Shriners Hospital for Children Northern California, Sacramento, CA, USA
| | - M Claire Manske
- Department of Orthopedic Surgery, Shriners Hospital for Children Northern California, Sacramento, CA, USA; Department of Orthopedic Surgery, University of California Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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Syed AN, Ashebo L, Lawrence JTR. Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures. J Pediatr Orthop 2024; 44:e124-e130. [PMID: 37904588 DOI: 10.1097/bpo.0000000000002552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Both bone forearm fractures are common injuries in children. Most can be treated with reduction and casting. Those that fail nonoperative management can be treated with a plate or intramedullary fixation; however, refracture remains a problem. The goal of this study is to evaluate the refracture rate in both bone forearm fractures based on the mode of fixation. METHODS Institutional board review approval was obtained. A retrospective chart review from 2010 to 2021 at a single tertiary care institution was conducted for all operative patients <18 years who sustained a both bone forearm fracture. Groups were stratified based on initial operative fixation type: both bones fixated using nails, 1 bone fixated with a nail; both bones plated, and 1 bone plated. Further review was conducted to identify refractures following initial operative treatment. Statistical analyses were conducted using the χ 2 test of independence and Fisher's exact test. RESULTS In all, 402 operatively treated both bone forearm fracture patients were identified. Two hundred fifty-six of these patients underwent intramedullary fixation (average age 10.3y/o), while 146 patients received plate fixation (average age 13.8y/o). Fracture location was similar across the nailing and plating cohorts, most often occurring in the mid-shaft region. Patients aged ≤10 years refractured at a significantly higher rate than patients aged >10 years across all operative fixation cohorts (12.5% vs. 2.5%, P <0.001). Among the 256 patients who underwent intramedullary fixation, 61.3% had both bones treated (n=157/256), whereas 38.7% received single bone fixation (n=99/256). Of the 146 plate fixations, 84.4% had both bones fixed (n=123/146), and only 15.8% were treated with single bone fixation (n=23/146). In the intramedullary group, 15 patients sustained refractures, 11 of whom were treated with single bone fixation (11.1%, n=11/99) versus 4 with both both fixation (2.5%, n=4/157). Among the plating group, 7 patients sustained refractures, 6 with both bone fixation (4.9%, n=6/123) and 1 in single bone fixation (4.3%, n=1/23). Refractures were found to be significantly more prevalent among patients treated with single bone compared with both bone intramedullary nail fixation (11.1% vs. 2.5%, P =0.006). By fixated bone, single bone ulna fixations had a higher refracture rate compared with both bone fixations (12.1% vs. 3.6%, P =0.003). CONCLUSION The overall refracture rate following operative treatment of both bone fractures is 5.5% and is similar between intramedullary and plate fixations. Overall, patients ≤10 years of age had a higher rate of refracture. Among single bone fixations, higher refracture was seen with intramedullary fixations, and when the radius was treated nonoperatively. Surgeons may be able to reduce the refracture rate by performing intramedullary fixation of both bones instead of only one bone. Effective postoperative counseling among younger patients may also decrease refracture rates.
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Affiliation(s)
- Akbar Nawaz Syed
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Ishihara N, Tokutake K, Takegami Y, Asami Y, Kumagai H, Ota H, Kimura Y, Ohshima K, Imagama S. An age-matched comparative study on intramedullary nailing and plate fixation of both-bone diaphyseal forearm fracture in adolescents. Eur J Orthop Surg Traumatol 2024; 34:441-450. [PMID: 37573542 DOI: 10.1007/s00590-023-03679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis. METHODS Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared. RESULTS The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so. CONCLUSIONS Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs. LEVEL OF EVIDENCE IV Multicenter retrospective study.
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Affiliation(s)
- Noriko Ishihara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuta Asami
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Kumagai
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-cho, Nakagawa-ku, Nagoya, 454-8502, Japan
| | - Hideyuki Ota
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-cho, Nakagawa-ku, Nagoya, 454-8502, Japan
| | - Yoshihiko Kimura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuma Ohshima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Kapadia AB, Wilson PL, Gill CS, Wyatt CW, Montgomery GK, Huang SG, Ellis HB. Characteristics of forearm refracture in adolescents. J Pediatr Orthop B 2024; 33:58-64. [PMID: 36723612 PMCID: PMC10686275 DOI: 10.1097/bpb.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate characteristics of reinjury following forearm fractures in adolescents. An Institutional Review Board-approved retrospective cohort study of forearm fractures (ages 10-18 years) treated by a single academic pediatric orthopaedic group from June 2009 to May 2020 was conducted. All both bone forearm (BBFA) and radius or ulna primary and secondary injuries were included. We excluded open, surgically treated, physeal, epiphyseal, and radial head/neck fractures. Demographics, injury characteristics, and radiographic data were recorded. We evaluated associations of ipsilateral same-site refracture (RE-FRACTURE) versus ipsilateral or contralateral different-site forearm fractures occurring as secondary later injuries (OTHER). Thirty-three of 719 patients sustained a secondary forearm fracture (4.6%; mean age, 11.5 years; M:F, 5.6:1). RE-FRACTURES, compared with OTHER forearm locations, were associated with a sports mechanism at time of original injury ( P = 0.024) and mid-shaft position of fracture on the radius (77.6 vs. 29.8 mm from distal physis; P < 0.001) and ulna (72.0 vs. 27.2 mm from distal physis; P = 0.003). RE-FRACTURES also demonstrated increased radius to ulna distance between BBFA primary injury sites on anteroposterior (19.6 vs. 10.6 mm; P = 0.009) and lateral radiographs (19.6 vs. 10.5 mm; P = 0.020) compared with OTHER forearm locations. Residual angulation and fracture-line visibility were not significantly associated with secondary fracture. Ipsilateral same-site refractures tend to occur in adolescents within 1 year following treatment for widely spaced (>15 mm) and mid-shaft forearm fractures incurred during athletic activity. Further research may be warranted to evaluate biologic, bone health, or personality traits that may lead to secondary fractures of the pediatric forearm.
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Affiliation(s)
- Ami B. Kapadia
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Philip L. Wilson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedics and Sports Medicine, Scottish Rite for Children
- Division of Sports Medicine, Children’s Medical Center Dallas, Dallas, Texas, USA
| | - Corey S. Gill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedics and Sports Medicine, Scottish Rite for Children
- Division of Sports Medicine, Children’s Medical Center Dallas, Dallas, Texas, USA
| | - Charles W. Wyatt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedics and Sports Medicine, Scottish Rite for Children
| | | | - Sharon G. Huang
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Henry B. Ellis
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedics and Sports Medicine, Scottish Rite for Children
- Division of Sports Medicine, Children’s Medical Center Dallas, Dallas, Texas, USA
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Rust A, Samade R, Campbell AB, McManus T, Jain SA. Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures. Eur J Orthop Surg Traumatol 2024; 34:135-142. [PMID: 37368153 DOI: 10.1007/s00590-023-03560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/23/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). METHODS Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. RESULTS A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). CONCLUSION A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. LEVEL OF EVIDENCE Therapeutic Level III (Retrospective Cohort).
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Affiliation(s)
- Andrew Rust
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Richard Samade
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Andrew B Campbell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Timothy McManus
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sonu A Jain
- Departments of Orthopaedics and Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH, 43212, USA.
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Guzel I. Comparison of four surgical methods for pediatric forearm double diaphyseal fractures: a retrospective analysis. Eur Rev Med Pharmacol Sci 2023; 27:9058-9066. [PMID: 37843319 DOI: 10.26355/eurrev_202310_33931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE One of the most frequent fractures in children is a double forearm fracture. They make up 26% of children's long bone fractures in the upper extremities and their incidence has increased in recent years. In this study, pediatric patients with double forearm fractures were treated using plate screw, intramedullary K-wire (I-KW), intramedullary titanium elastic nails (TENs), and hybrid fixation (HF) to compare the radiographic and functional results. PATIENTS AND METHODS The printed and digital medical records were retrospectively examined from our hospital's archives after receiving consent from the regional ethics committee. Legal guardians of the patients, who were under the age of 18, gave their informed consent. Based on the surgical procedure used, the patients were split into 4 groups. Double plating was the D-P group, hybrid fixation method was the HF group, intramedullary elastic titanium nail was the TEN group, and intramedullary K-wire was the I-KW group. The study comprised 78 patients in total, with 19 patients in the HF group, 21 patients in the TEN group, 20 patients in the I-KW group, and 18 patients in the D-P group. RESULTS When the mean operating times of the four approaches were compared, a substantial difference was found. The D-P group's mean operating time (65.2±4.9 minutes) was noticeably longer than those of the other groups (p<0.001). The HF group's mean operating time was 55.93.4 min longer than that of the TENs and I-KW groups, which was statistically significant (p<0.001). In comparison to the other groups, the D-P group's mean intraoperative fluoroscopy time was considerably shorter (6±3 sec) (p<0.001). When compared to the D-P group, it was considerably higher in the HF group (12±2 sec) (p<0.001). In comparison to the TENs (20±4 sec) and I-KW groups (19±5 sec), it was significantly lower in the HF group (p<0.001). In comparison to the HF group, the D-P group's tourniquet use lasted much longer (p<0.001). The TENs and I-KW groups did not use a tourniquet because a mini-incision was made. The D-P group's mean blood loss (110±10 ml) was substantially larger than that of the other groups (p<0.001) in the mean blood loss data. In comparison to the TENs (40±5 ml) and I-KW (40±5 ml) groups, the mean blood loss in the HF group (90±10 ml) was considerably larger (p<0.001). All patients received an above-elbow postoperative cast. The HF group (2 weeks) and the D-P group (2 weeks) experienced significantly less postoperative immobility than the TENs and I-KW groups (4.4 weeks, p<0.001). CONCLUSIONS The four fixation techniques used in the current study for juvenile diaphyseal double forearm fractures produced positive clinical and functional outcomes. The hybrid fixation technique was discovered to be comparable to the other techniques and even beneficial in some ways. So, a safe and efficient treatment option for juvenile diaphyseal double forearm fractures is hybrid fixation.
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Affiliation(s)
- I Guzel
- Department of Orthopedics and Traumatology, Malatya Turgut Turgut Özal University, Training and Research Hospital, Malatya, Turkey.
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13
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Cohen N, Gigi R, Haberman S, Capua T, Rimon A. Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:702-706. [PMID: 35947064 DOI: 10.1097/pec.0000000000002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery. METHODS This retrospective cohort study included all patients aged 0 to 18 years who presented to our pediatric ED with an extraarticular forearm fracture treated with closed reduction between May 2017 and April 2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt. RESULTS Of 375 patients (median age 8.1 years, 294 [78.2%] boys), 44 (11.7%) patients sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, P < 0.001), open fracture (aOR 10.1, P = 0.007), midshaft fracture (aOR 2.6, P = 0.004), radial translation rate 37% and higher in either plane (aOR 5.1, P = 0.004), and age of 10 years and older (aOR 2.9, P = 0.01). CONCLUSIONS Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.
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Affiliation(s)
| | | | - Shira Haberman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Serra Lopez VM, Wu CH, Bozentka DJ. Complications and Revision Surgery of Forearm Fractures. Hand Clin 2023; 39:295-306. [PMID: 37453758 DOI: 10.1016/j.hcl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Nonunion or malunion of forearm fractures may result in restricted range of motion or persistent pain, leading to limitations in activities of daily living. Complications may also present in the form of ectopic bone growth or persistent infections. A systematic method to evaluate complications resulting from forearm fractures is helpful to both determine the cause for the failure and plan for adequate reconstruction.
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Affiliation(s)
- Viviana M Serra Lopez
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
| | - Chia H Wu
- Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX 77030, USA
| | - David J Bozentka
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
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Abstract
UPDATE This article was updated on July 19, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 1080, in the last sentence of the Results section of the Abstract, the text that had read "0.05% (4 of 777)" now reads "0.5% (4 of 777)." BACKGROUND The risk of fracture-related nerve injury associated with forearm fractures in children is unknown. The purposes of the present study were to calculate the risk of fracture-related nerve injury and to report the institutional rate of complications of surgical treatment of pediatric forearm fractures. METHODS Four thousand, eight hundred and sixty-eight forearm fractures (ICD-10 codes S52.0 to S52.7) that had been treated in our tertiary level pediatric hospital between 2014 and 2021 were identified in our institutional fracture registry. Of these, 3,029 fractures occurred in boys and 53 were open fractures. Sex, age at injury, trauma mechanism and energy, fracture type, treatment method, and cause and type of nerve injury were assessed in 43 patients with 44 registered nerve injuries. Patients with nerve injuries were reevaluated to calculate the recovery time. Univariable and multivariable regression analyses were performed to determine the risk of nerve injury. RESULTS The risk of a fracture-related nerve injury was 0.7% (33 of 4,868). Only 2 injuries were permanent; thus, the risk of permanent nerve injury associated with a forearm fracture was 0.04% (2 of 4,868). The ulnar nerve was affected in 19 cases; the median nerve, in 8; and the radial nerve, in 7. In cases of open fracture, the risk of nerve injury was 17% (9 of 53). Open fractures had an OR of 33.73 (95% CI, 14.97 to 70.68) on univariate analysis and an OR of 10.73 (95% CI 4.50 to 24.22) on multivariate analysis with adjustment for female sex and both-bone diaphyseal fracture. Both-bone diaphyseal fracture (ICD-10 code S52.4) had an OR of 9.01 (95% CI, 4.86 to 17.37) on univariate analysis and an OR of 9.98 (95% CI 5.32 to 19.47) on multivariate analysis with adjustment for age and female sex. Overall, 777 fractures were internally fixed. The risk of nerve injury as a complication of internal fixation was 1.3% (10 of 777). Four of these iatrogenic injuries (including 2 involving the median nerve, 1 involving the ulnar nerve, and 1 involving the radial nerve) were permanent; thus, the risk of permanent nerve injury as a complication of internal fixation was 0.5% (4 of 777). CONCLUSIONS Nerve injury following a pediatric forearm fracture is rare and has an excellent potential for spontaneous recovery. In the present study, all of the permanent nerve injuries occurred in association with open fractures or as a complication of internal fixation. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kaj Zilliacus
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Topi Laaksonen
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Matti Ahonen
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Petra Grahn
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Folkman MJ, Ren BO, Maheshwer B, Klyce WB, Mistovich RJ. Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation. J Pediatr Orthop 2023; 43:e446-e450. [PMID: 37072917 DOI: 10.1097/bpo.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Pediatric forearm fractures are common injuries and can sometimes require surgical treatment. Few studies have evaluated the long-term outcomes of pediatric forearm fracture plating. We evaluated long-term functional outcomes and satisfaction in children with forearm fractures treated with plate fixation. METHODS We performed a single-institution case series at a pediatric level 1 trauma center. Inclusion criteria were: patients with radius and/or ulna diaphyseal fractures, index surgery at 18 years of age or younger, plate fixation, and a minimum of 2 years follow-up. We surveyed patients with the QuickDASH outcome measure and supplemented this with functional outcomes and satisfaction questions. Demographics and surgery characteristics were obtained from the electronic medical record. RESULTS A total of 41 patients met the eligibility criteria, of whom 17 completed the survey with a mean follow-up of 7.2 ± 1.4 years. The mean age at index surgery was 13.1 ± 3.6 years (range, 4 to 17), with 65% males. All patients reported at least one symptom, with aching (41%) and pain (35%) occurring most frequently. There were 2 complications (12%), including one infection and one compartment syndrome treated with fasciotomy. Hardware removal occurred in 29% of patients. There were no refractures. The mean QuickDASH score was 7.7 ± 11.9, with an occupation module score of 1.6 ± 3.9 and a sports/performing arts module score of 12.0 ± 19.7. The mean surgery satisfaction was 92% and scar satisfaction was 75%. All patients returned to prior activities and 88% reported a return to their preoperative baseline level of function. CONCLUSIONS Plate fixation for pediatric forearm fractures achieves osseous union but not without the potential for long-term sequelae. All patients reported residual symptoms 7 years later. Scar satisfaction and return to baseline function were imperfect. Patient education for long-term outcomes of surgery is essential, especially in the transition to adulthood. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Matthew J Folkman
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Bryan O Ren
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Bhargavi Maheshwer
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
| | - Walter B Klyce
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
| | - R Justin Mistovich
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
- Division of Orthopaedic Surgery, MetroHealth System, Cleveland
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Abstract
INTRODUCTION Forearm fractures are a common pediatric injury. Currently, there is no consensus on treatment for fractures that recur following initial surgical fixation. The objective of this study was to investigate the subsequent fracture rate and patterns and describe the treatment of these forearm fractures. METHODS We retrospectively identified patients who underwent surgical treatment for an initial forearm fracture at our institution between 2011 and 2019. Patients were included if they sustained a diaphyseal or metadiaphyseal forearm fracture that was initially treated surgically with a plate and screw construct (plate) or elastic stable intramedullary nail (ESIN), and if they subsequently sustained another fracture that was treated at our institution. RESULTS A total of 349 forearm fractures were treated surgically with ESIN or a plate fixation. Of these, 24 sustained another fracture, yielding a subsequent fracture rate of 10.9% for the plate cohort and 5.1% for the ESIN cohort ( P =0.056). The majority of plate refractures (90%) occurred at the proximal or distal plate edge, while 79% of the fractures treated previously with ESINs occurred at the initial fracture site ( P <0.001). Ninety percent of plate refractures required revision surgery, with 50% underwent plate removal and conversion to ESIN, and 40% underwent revision plating. Within the ESIN cohort, 64% were treated nonsurgically, 21% underwent revision ESINs, and 14% underwent revision plating. Tourniquet time for revision surgeries were shorter for the ESIN cohort (46 vs. 92 min; P =0.012). In both cohorts, all revision surgeries had no complications and healed with evidence of radiographic union. However, 9 patients (37.5%) underwent implant removal (3 plates and 6 ESINs) after subsequent fracture healing. CONCLUSIONS This is the first study to characterize subsequent forearm fractures following both ESIN and plate fixation and to describe and compare treatment options. Consistent with the literature, refractures following surgical fixation of pediatric forearm fractures may occur at a rate ranging from 5% to 11%. ESINs are both less invasive at the time of initial surgery and can often be treated nonoperatively if there is a subsequent fracture, while plate refractures are more likely to be treated with a second surgery and have a longer average surgery time. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Affiliation(s)
- Amelia M Lindgren
- Rady Children's Hospital-San Diego
- University of California San Diego, San Diego, CA
| | - Gabriela Sendek
- Rady Children's Hospital-San Diego
- University of California San Diego, San Diego, CA
| | | | | | - Andrew T Pennock
- Rady Children's Hospital-San Diego
- University of California San Diego, San Diego, CA
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Perruisseau-Carrier A, Tilhet L, Rouanet M, Henry AS, Hu W. Management of Complex Forearm Injuries: Our Strategy of Reconstruction and Clinical Results. Ann Plast Surg 2023; 90:S203-S208. [PMID: 36752518 DOI: 10.1097/sap.0000000000003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an "as early as possible" reconstruction.
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Affiliation(s)
| | - Laura Tilhet
- From the Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Brest University Hospital, Brest, France
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Gursanscky J, Kelly AM, Hamad A, Tagg A, Klim S, Ritchie P, Law I, Krieser D. Outcome of reduction of paediatric forearm fracture by emergency department clinicians. Emerg Med Australas 2023; 35:347-349. [PMID: 36596645 DOI: 10.1111/1742-6723.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
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Affiliation(s)
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Hamad
- School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Tagg
- Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | | | - Ian Law
- Western Health, Melbourne, Victoria, Australia
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Ohshima K, Tokutake K, Takegami Y, Asami Y, Matsubara Y, Natsume T, Kimura Y, Ishihara N, Imagama S. Longer time of implantation using the buried pin technique for intramedullary nailing would decrease refracture in the diaphyseal forearm fracture in children-retrospective multicenter (TRON) study. Injury 2023; 54:924-929. [PMID: 36642566 DOI: 10.1016/j.injury.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Intramedullary nailing using Kirschner wires in pediatric diaphyseal forearm fractures is often performed as a less invasive treatment than plate fixation, but it remains controversial whether the tips of Kirschner wires are buried or exposed. The purpose of this study was to investigate the relationship between whether the tips are buried or exposed and complications, especially of refracture. METHODS Data of 405 patients under 16 years who underwent surgical treatment for diaphyseal forearm fractures in our 11 hospitals between 2010 and 2020 were collected. Finally, 143 patients who underwent intramedullary nailing with at least 6-month follow-up were analyzed. We investigated difference in complication rates depending on whether the Kirschner wire tips were buried (Group B: n = 79) or exposed (Group E: n = 64). Regarding refractures, we also examined time of onset and status of bone union before the refracture occurred. RESULTS The duration before implant removal in Group B was more than 4 times longer than that in Group E (mean 187.9 vs. 41.4 days, p<0.001), although there was no significant difference in the progression of bone union between the two groups. Regarding postoperative complications, Group B had a significantly lower rate of refractures than Group E (7.9% vs. 32.8%, p<0.001), although the rate of irritation pain was significantly higher (15.2% vs. 1.6%, p = 0.006). The infection rate was also lower in Group B than Group E, but not significantly so (3.8% vs. 10.9%, p = 0.112). Refractures between 3 and 9 months after surgery accounted for 66.7% of all refractures, and those within 3 months accounted for 14.5% of all fractures. There was no significant difference in the status of bone union before the refracture occurred between patients with and without refracture. CONCLUSIONS The present study showed that longer time of implantation using the buried pin technique for intramedullary nailing reduces refracture of pediatric diaphyseal forearm fractures. Because of the risk of refracture during remodeling, we recommend the implantation of intramedullary nailing for 6-9 months and the instruction for the patients and the parents to pay more attention to refracture at least within 9 months postoperatively. LEVEL OF EVIDENCE Level Ⅲ, Multicenter retrospective study.
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Affiliation(s)
- Kazuma Ohshima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuta Asami
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya-shi 448-0851, Japan
| | - Tadahiro Natsume
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya-shi 448-0851, Japan
| | - Yoshihiko Kimura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Noriko Ishihara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Nolte M, Luchetti T, Bohl D, Kogan M. Comparison of waterproof versus cotton cast liners on cast index in pediatric forearm fractures. Acta Orthop Belg 2022; 88:733-737. [PMID: 36800657 DOI: 10.52628/88.4.8619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Achieving an adequate cast mold is critical for successful nonoperative management of pediatric forearm fractures. A high cast index (>0.8) is as- sociated with an increased risk of loss of reduction and failure of conservative management. Waterproof cast liners offer improved patient satisfaction compared to conventional cotton liners, however they may carry different mechanical properties compared to traditional cotton liners. The purpose of this study was to determine whether the cast index differs between waterproof and traditional cotton cast liners when used to stabilize pediatric forearm fractures. We retrospectively reviewed all forearm fractures casted in a pediatric orthopedic surgeon's clinic between December 2009 and January 2017. Either a waterproof or cotton cast liner was utilized according to parent and patient preferences. The cast index was determined on follow-up radiographs and compared between groups. Overall, 127 fractures met the criteria for this study. Twenty-five fractures had waterproof liners and 102 fractures had cotton liners placed. Waterproof liner casts showed a significantly higher cast index (0.832 vs 0.777; p=0.001), with a significantly higher proportion of casts with index greater than 0.8 (64.0% vs 35.3%; p=0.009). The use of waterproof cast liners is associated with a higher cast index compared to traditional cotton cast liners. Although waterproof liners may be associated with higher patient satisfaction scores, providers should be aware of this difference in mechanical properties and may consider altering their casting technique accordingly.
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Tay LHGM, Tan WXT, Lee NKL, Chew EM, Mahadev A, Wong KPL. Retrospective analysis: risk factors predicting failure of closed reduction in pediatric diaphyseal forearm fractures treated with elastic stable intramedullary nails (ESINs). J Pediatr Orthop B 2022; 31:465-470. [PMID: 35045006 DOI: 10.1097/bpb.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEVEL OF EVIDENCE Level IV.
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Subaşi İÖ, Alemdaroğlu KB, Arican G, Iltar S, Şibar K, Özmeriç A. Cast revision is effective for critical three-point index values in paediatric forearm fractures: a prospective study. J Pediatr Orthop B 2022; 31:457-464. [PMID: 35132001 DOI: 10.1097/bpb.0000000000000960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Three-point index (TPI) has been reported to be effective in predicting the displacement of forearm fractures. The aim of this prospective study was to investigate the clinical efficacy of recasting critical but acceptable casts according to three-point index (0.6 < TPI < 0.8) before a redisplacement occurs in childhood forearm fractures. A TPI of 0.6-0.8 was determined in 68 patients, and these were separated as group 1 ( n = 34) applied with prophylactic recasting and group 2 ( n = 34) where treatment was continued with same cast. The remaining 28 patients had TPI < 0.6 and were assigned as group 3. Groups were compared in respect of age, initial displacement, cast type, location of fracture, initial and late three-point index values and inter- and intraobserver reliabilities of TPI measurements. Significantly less displacement was seen in group 1 than in group 2 ( P = 0.004). It was found that a 0.1 increase of index value in the initial and late TPIs increases the probability of redisplacement by 5.06 and 7.78 times, respectively. Late TPI, measured 1 week after casting, had better predictive value than the initial TPI with a sensitivity of 77.8%, specificity of 92.3%, positive predictive value of 70% and negative predictive value of 94.7%. Patients in the grey zone will be able to safely complete the cast treatment with prophylactic recasting without surgical intervention. TPI should be remeasured at the end of first week, as its predictive value becomes more accurate after swelling subsides.
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Affiliation(s)
- İzzet Özay Subaşi
- Department of Orthopedics and Traumatology, Erzincan Binali Yildirim University, Erzincan
| | | | - Gökhun Arican
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serkan Iltar
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kemal Şibar
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Özmeriç
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
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Seefried S, Chin-Goh K, Sahakian V, Lightfoot N, Boyle M. Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia. N Z Med J 2022; 135:60-66. [PMID: 35999799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM Re-manipulation of paediatric forearm fractures under general anaesthetic may be required following inadequate closed reduction under conscious sedation. Manipulation under general anaesthetic carries significant inherent risks and is preferably avoided. We assessed one institution's experience with paediatric forearm fracture reduction and investigate the incidence of re-manipulation under general anaesthetic of fractures initially managed under conscious sedation without fluoroscopy. METHOD All paediatric forearm fractures presenting to the children's emergency department of our national children's hospital between 1 January 2019 and 30 June 2019 were studied. Radius and ulna fractures were categorised according to fracture location (distal third, middle third, proximal third), any associated injury, and any plan to proceed to the operating room that was documented prior to manipulation in the emergency department. Univariate and multivariate statistical analysis was carried out to test for differences between discrete and continuous data and odds ratios were calculated. RESULTS Three-hundred and nine patients presented during the study period with 267 being eligible for analysis. Fifteen point seven percent (42/267) required fracture manipulation in the operating theatre following initial reduction in the children's emergency department. Independent risk factors associated with significantly higher rates of failed reduction under conscious sedation (p<0.001-0004) were patients who had a delay in presentation to hospital, were older, or had a non-distal fracture site. CONCLUSION There are higher rates of re-manipulation under general anaesthetic in children presenting to the emergency department of our national children's hospital with forearm fractures than seen in comparative international studies. Risk factors which predict an inadequate initial reduction and interventions to improve this are discussed.
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Affiliation(s)
- Shaye Seefried
- Medicine, The University of Auckland Faculty of Medical and Health Sciences, New Zealand
| | - Kim Chin-Goh
- Orthopaedics, Starship Children's Health, New Zealand
| | - Vahe Sahakian
- Orthopaedic Department, Counties Manukau DHB, New Zealand
| | | | - Matthew Boyle
- Paediatric Orthopaedics, Starship Children's Health, New Zealand
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Wang F, Zhang R, Liu S, Ruan H, Xu J, Kang Q. Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm? Jt Dis Relat Surg 2022; 33:273-284. [PMID: 35852185 PMCID: PMC9361107 DOI: 10.52312/jdrs.2022.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives
This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand the term “spaghetti” from the wrist to forearm in such terrifying cases. Patients and methods
Data from a total of 50 patients (44 males, 6 females; mean age: 48.5±25.7 years; range, 10 to 70 years) who were treated for multicomponent soft tissue injuries of the wrist and forearm, including at least one major artery and one major nerve, between February 2020 and December 2021 were retrospectively analyzed. The patients were divided into the wrist injury group (n=30) and forearm injury group (n=20) according to the location of laceration. Demographic characteristics, including age, sex ratio and mechanism and side of injury, total lacerated structures, and outcomes, including tendon function, opposition, intrinsic muscle function, deformities, sensation and grip strength were evaluated. Results
In the wrist injury group, a mean of 12.27±3.53 structures at the volar side were injured. It took a mean time of 1.8±0.4 h for emergency surgical repair and, after a mean of 16.6±5.3 month follow-up, most patients received excellent/good outcomes in the six aspects. In the forearm injury group, a mean of 12.95±2.96 structures at the volar side were injured. It took an average time of 2.1±0.4 h for emergency surgical repair and, after a mean of 15.4±6.4 month follow-up, most patients received excellent/good outcomes and were satisfied with the functional recovery. Only surgical time (p=0.018) and final grip strength (p=0.023) between the two groups showed a statistically significant difference. Conclusion
We propose to merge the severe wrist and proximal forearm laceration of multiple tendons/muscles with at least one major artery and one major nerve as a whole, namely the spaghettiketchup injury, since the laceration of wrist and that of proximal forearm in this study share similar mechanisms and outcomes after primary repair or reconstruction.
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Affiliation(s)
| | | | | | | | | | - Qinglin Kang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China.
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26
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Flynn H, Solarz MK, Rehman S. Forearm Fractures: Diagnosis and Contemporary Treatment Strategies. Instr Course Lect 2022; 71:303-312. [PMID: 35254790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Diaphyseal forearm fractures represent a spectrum of injury patterns that include isolated radial shaft fractures, isolated ulnar shaft fractures, both-bone forearm fractures, Galeazzi fracture-dislocations, and Monteggia fracture-dislocations. Although less common than distal radius fractures, diaphyseal forearm fractures are still a frequently encountered clinical entity seen by orthopaedic surgeons, both as isolated injuries and in the patient with polytrauma. It is important to review the epidemiology of diaphyseal forearm fractures and the classification systems used to describe them, as well as to discuss the principles of the initial evaluation and management of these fractures. It is important to know the indications for nonsurgical and surgical management, along with the goals of surgical management, options for internal fixation, and surgical approaches to the forearm.
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27
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Zeng F, Jorgensen A, Chaudhry S. Late Flexor Entrapment in Neocortex After Pediatric Forearm Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00098. [PMID: 34449442 DOI: 10.2106/jbjs.cc.21.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A pediatric patient sustained an open Monteggia-equivalent fracture treated operatively. Despite uneventful fracture healing, late-onset extrinsic flexor tightness of the index finger occurred. A neocortex developed about the torn ulnar periosteum, entrapping the index flexor digitorum profundus muscle belly. Despite being 5 years postinjury, motion was improved after proximal muscle release. CONCLUSION Acute flexor entrapment is well-reported in forearm fractures; however, late-onset entrapment inside a neocortex is not. Although early recognition of restricted motion is ideal, even long-standing contractures may be amenable to improvement with appropriate treatment guided by the physical examination.
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Affiliation(s)
- Francine Zeng
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Anna Jorgensen
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Sonia Chaudhry
- Department of Orthopaedic Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
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British Orthopaedic Association Trauma Committee. British Orthopaedic Association Standard for Trauma (BOAST): Early Management of Paediatric Forearm Fracture. Injury 2021; 52:2052. [PMID: 34416974 DOI: 10.1016/j.injury.2021.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Murphy RF, Sleasman B, Osborn D, Barfield WR, Dow MA, Mooney JF. A Single Sugar-Tong Splint Can Maintain Pediatric Forearm Fractures. Orthopedics 2021; 44:e178-e182. [PMID: 33238016 DOI: 10.3928/01477447-20201119-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Displaced pediatric forearm fractures often are treated with closed reduction and immobilization. Recent literature demonstrates no difference in maintaining alignment or needing repeat intervention in patients immobilized with either a single sugar-tong splint or a long-arm cast, but most series include patients with distal fractures. This study included patients 3 to 15 years old who underwent closed reduction and immobilization for displaced midshaft or proximal forearm fractures. Radiographs from the time of injury, after reduction, and at 4-week follow-up were reviewed for coronal and sagittal plane angular alignment. Secondary interventions also were recorded. A total of 121 patients (70 long-arm cast, 51 simple sugar-tong splint) met inclusion criteria. Groups were matched in terms of age (P=.95), sex (P=.41), body mass index (P=.12), and angular deformity prior to reduction in the sagittal (P=.78) and coronal (P=.83) planes. Following closed reduction, sagittal (P=.003) and coronal (P=.002) alignment improved significantly in all patients. At 4-week follow-up, there were no significant differences in sagittal (P=.15) or coronal (P=.68) alignment between the 2 groups. Nine patients underwent a secondary intervention after the index reduction (long-arm cast, n=7; simple sugar-tong splint, n=2), with no statistically significant difference between groups (P=.30). There were no statistically significant differences between patients managed with long-arm cast or simple sugar-tong splint regarding residual sagittal or coronal plane deformity at 4-week follow-up or incidence of secondary intervention. These findings indicate simple sugar-tong splint and long-arm cast appear to be acceptable and equivalent methods of immobilization for these injuries. [Orthopedics. 2021;44(2):e178-e182.].
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Abihssira S, Gerosa T, Masmejean EH. Complete Fasciotomy Using a Radial Approach for Acute Forearm Compartment Syndrome: A New Technique. Tech Hand Up Extrem Surg 2021; 26:23-25. [PMID: 33899823 DOI: 10.1097/bth.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute forearm compartment syndrome is damaging but rare. Early treatment reduces mid and long-term sequelae. The palmar compartment is most frequently involved but the dorsal compartment and mobile wad are also at risk. Multiple fasciotomies approaches have been described but are associated with long-term complications. In particular, wound management is important. Mini-invasive techniques are not available for acute forearm compartment syndrome. Acute leg release via a single approach has been developed and proven effective. Likewise, we present a lateral S-shaped approach for fasciotomies of the 3 forearm compartments in the case of acute forearm compartment syndrome.
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Affiliation(s)
- Sharon Abihssira
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP)
| | - Thibault Gerosa
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP)
- University of Paris
| | - Emmanuel H Masmejean
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP)
- University of Paris
- Clinique Blomet, Research Unit, Paris, France
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Lohmander LS, Harris IA. Is there a reason to challenge our current practice in children's forearm fractures? Acta Orthop 2021; 92:127-128. [PMID: 33297804 PMCID: PMC8158220 DOI: 10.1080/17453674.2020.1854505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Sweden
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South Wales, and Department of Orthopaedic Surgery, Liverpool Hospital, Liverpool, NSW, Australia
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Kluijfhout WP, de Vries EN, de Ridder VA, de Bruin IGJM. [Compartment syndrome of the forearm in a child]. Ned Tijdschr Geneeskd 2021; 165:D5446. [PMID: 33793125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Compartment syndrome is a rare but serious entity with various causes. Timely diagnosis and treatment are essential. CASE DESCRIPTION We present a case of a 14-year-old boy with a crush injury of the forearm including a fracture of the radius and ulna. In addition, a traction injury of the brachial plexus was present. Despite the absence of pain, a fasciotomy was performed because of excessive swelling of the forearm with obvious bulging of the muscles intra-operatively. CONCLUSION Compartment syndrome can develop at several places in the body, including the forearm. Disproportional pain is the most relevant symptom which can however be absent due to concurrent neurological injury. Surgical exploration is always warranted in case of a clinical suspicion of compartment syndrome to prevent severe complications.
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Tsumura T, Matsumoto T, Kishimoto K, Shiode H. Thorough Debridement Facilitated by Timely Planning of One-Bone Forearm Surgery: A Report of 2 Cases. JBJS Case Connect 2020; 10:e19.00635. [PMID: 33512925 DOI: 10.2106/jbjs.cc.19.00635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASES Two patients with complex open forearm fractures underwent initial treatment with radioulnar fusion (arthrodesis of the radius to the ulna)-one patient sustained elbow and forearm injuries in a car accident and the other had an elbow injury caused by conveyor belt entanglement. CONCLUSIONS Differentiating viable tissue from nonviable tissue is important in the management of potentially contaminated wounds. Arthrodesis of the radius to the ulna is generally considered a salvage option for complicated forearm instability. The decision to perform arthrodesis of the radius and ulna in the initial treatment facilitated the management of soft-tissue injuries and helped prioritize hand function.
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Affiliation(s)
- Takuya Tsumura
- Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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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 Orthop Traumatol Turc 2020; 54:378-384. [PMID: 32442119 DOI: 10.5152/j.aott.2020.19128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Hepping AM, Barvelink B, Ploegmakers JJW, van der Palen J, Geertzen JHB, Bulstra SK, Harbers JS, Stevens M. Recovery of strength after reduced pediatric fractures of the forearm, wrist or hand; A prospective study. PLoS One 2020; 15:e0230862. [PMID: 32236117 PMCID: PMC7112181 DOI: 10.1371/journal.pone.0230862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The way strength recovers after reduction of pediatric fractures of the upper extremity has not previously been the specific scope of research. This is remarkable, since strength measurements are often used as an outcome measure in studies on trauma of the upper extremity. The aim of this study was to evaluate how strength recovers after sustainment of fractures of the forearm, wrist or hand treated by closed or open reduction in children and adolescents in the first 6 months after trauma. How much strength is lost at 6 weeks, 3 months and 6 months after trauma, and is this loss significant? Are there differences in the pattern of recovery between children who underwent a different treatment? And finally, which of the following factors are associated with an increase in the ratio between affected grip strength and expected strength: type of fracture, cast immobilization, occurrence of complications, and degree of pain? Design Prospective observational study. Participants Children and adolescents aged 4–18 years with a reduced fracture of the forearm, wrist or hand. Methods Grip strength, key grip and three-jaw chuck grip were measured twice in each hand 6 weeks, 3 months and 6 months after trauma. Details on fracture type and location, treatment received, cast immobilization and complications were obtained. Hand-dominance and pain were verbally confirmed. Results Loss of strength was more prominent and prolonged the more invasive the treatment, hence most extensive in the group receiving open reduction with internal fixation (ORIF), intermediate in the group receiving closed reduction with percutaneous pinning (CRIF), and least extensive in the group undergoing closed reduction without internal fixation (CR). Besides time passed, gender and age were of significant influence on strength, although there was no difference in pattern of recovery over time between children who received a different treatment. In the period of 6 weeks to 3 months after trauma, female gender, type of fracture sustained and occurrence of an unwanted event were associated with an increased ratio between affected and expected grip strength. For the later phase of recovery, between 3 and 6 months, this was only true for the occurrence of an unwanted event.
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Affiliation(s)
- Ann M. Hepping
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
- * E-mail:
| | - Britt Barvelink
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joris J. W. Ploegmakers
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Medical School Twente, Enschede, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jorrit S. Harbers
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Kocaoğlu H, Kalem M, Kavak M, Şahin E, Başarır K, Kınık H. Comparison of operating time, fluoroscopy exposure time, and functional and radiological results of two surgical methods for distal forearm fractures of both-bones in pediatric patients: Is it necessary to fix both bones? Acta Orthop Traumatol Turc 2020; 54:155-160. [PMID: 32254031 DOI: 10.5152/j.aott.2020.02.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the functional results of internal fixation of both forearm bones versus fixation of the radius alone in the treatment of distal both-bone forearm fractures in children. METHODS This study included a total of 34 children who were treated for distal forearm both-bone fracture. Patients were divided into two groups according to the technique used, which depended on the date of their surgery. Group 1 consisted of 18 children (14 males and four females; mean age: 10.3 years; age range: 7-16 years) who underwent both-bone fracture fixation using closed reduction and percutaneous pinning; Group 2 consisted of 16 children (12 males and four females; mean age: 10.1 years; age range: 6-15 years) who underwent only radius fracture fixation. The average follow-up was 65.6 months in Group 1 and 38.9 months in Group 2. Operating time, fluoroscopy exposure time, functional results (Mayo Wrist Score, visual analogue scale score, and range of motion), radiological results (time to union and malunion), and complications were recorded as outcome parameters. RESULTS The mean operating time was 35 min (range: 30-45 min) in Group 1 and 19 min (range: 10-25 min) in Group 2 (p<0.001). The mean fluoroscopy exposure time was 54 sec (range: 40-70 sec) in Group 1 and 18 sec (range: 10-26 sec) in Group 2 (p<0.001). Only three patients in Group 1 and four patients in Group 2 exhibited <10° of limitation in pronation and supination. No significant differences were determined between the groups with respect to functional scores (p=1.000). Final follow-up radiographs showed no malalignment in either group. In terms of time to union, there was no significant difference between groups (p=1.000). Additionally, only three minor complications associated with the pin track (two patients in Group 1 and one patient in Group 2) were noted. CONCLUSION In children with distal both-bone fractures, fixation of the radius fracture alone may be considered as an alternative method of treatment to fixation of both forearm bones as it results in satisfactory functional and radiographic outcomes. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Hakan Kocaoğlu
- Department of Orthopedics and Traumatology, İbn-i Sina Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Mahmut Kalem
- Department of Orthopedics and Traumatology, İbn-i Sina Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Mustafa Kavak
- Department of Orthopedics and Traumatology, Eskişehir Osmangazi University, School of Medicine, Eskişehir, Turkey
| | - Ercan Şahin
- Department of Orthopedics and Traumatology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Kerem Başarır
- Department of Orthopedics and Traumatology, İbn-i Sina Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hakan Kınık
- Department of Orthopedics and Traumatology, İbn-i Sina Hospital, Ankara University, School of Medicine, Ankara, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gondolini G, Schiavi P, Pogliacomi F, Ceccarelli F, Antonetti T, Zasa M. Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders. Clin J Sport Med 2019; 29:476-481. [PMID: 31688178 DOI: 10.1097/jsm.0000000000000539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years). DESIGN Case series. LEVEL OF EVIDENCE IV. SETTING University Hospital/Private Practice. PATIENTS Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years. INTERVENTIONS A MOF to obtain decompression of all compartments was performed in all patients. MAIN OUTCOME MEASURES Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation. RESULTS A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week. CONCLUSIONS Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery. CLINICAL RELEVANCE Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.
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Affiliation(s)
| | - Paolo Schiavi
- Clinica Mobile nel Mondo, World Motorbike Championships (MotoGP & WSBK) Medical Division, Parma, Italy
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Francesco Pogliacomi
- Clinica Mobile nel Mondo, World Motorbike Championships (MotoGP & WSBK) Medical Division, Parma, Italy
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Francesco Ceccarelli
- Clinica Mobile nel Mondo, World Motorbike Championships (MotoGP & WSBK) Medical Division, Parma, Italy
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Tommaso Antonetti
- Clinica Mobile nel Mondo, World Motorbike Championships (MotoGP & WSBK) Medical Division, Parma, Italy
- Sports Medicine Unit, Public Health Department of Parma, Parma, Italy
| | - Michele Zasa
- Clinica Mobile nel Mondo, World Motorbike Championships (MotoGP & WSBK) Medical Division, Parma, Italy
- Curriculum of Sport Sciences and Physical Exercise, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Zhu S, Yang D, Gong C, Chen C, Chen L. A novel hybrid fixation versus dual plating for both-bone forearm fractures in older children: A prospective comparative study. Int J Surg 2019; 70:19-24. [PMID: 31408746 DOI: 10.1016/j.ijsu.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/20/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the clinical outcomes of hybrid fixation using elastic stable intramedullary nailing (ESIN) for the ulna and plate screw fixation for the radius (Hybrid group) with dual plating fixation for both-bone forearm fractures in children between 10 and 16 years of age. METHODS Twenty-six patients were treated using a hybrid fixation struct and 30 patients were treated with dual plating fixation. The two groups were compared prospectively according to perioperative data and patient outcome measures. RESULT The hybrid fixation construct group had 26 patients, with a mean age of 13.27 years (range, 10-16 years) and the dual plate group had 30 patients, with a mean age of 13.33 years (range, 10-16 years). The groups were similar for sex, arm injured, fracture location. Incision length of ulna, duration of surgery and hospital costs were significantly different between the two groups (P < 0.05). There was no significant difference in either time to union or Price scores for function evaluation between the 2 groups (P < 0.05). Complication rates were also similar between the groups. CONCLUSION Hybrid fixation, using open reduction and internal fixation with a plate-and-screw construct on the radius and closed reduction and elastic intramedullary fixation of the ulna, is an acceptable method for treating both-bone diaphyseal forearm fractures in skeletally immature patients 10-16 years old. The small incision and less cost are the characteristics of this hybrid fixation.
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Affiliation(s)
- Shaoyu Zhu
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, PR China; Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang Province, China.
| | - Di Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, PR China; Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China.
| | - Chen Gong
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, PR China.
| | - Chunmao Chen
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, PR China.
| | - Liang Chen
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, PR China.
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Abstract
Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.Level of Evidence: Level III; retrospective study; therapeutic study.
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Affiliation(s)
| | | | - Lasse Hagen
- Center for Orthopaedics and Trauma Surgery, University Hospital Gießen and Marburg, Marburg
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Gießen and Marburg, Marburg
| | - Antonio Krüger
- Department of Trauma Surgery and Reconstructive Surgery, Diakonie Klinikum Jung-Stilling, Siegen, Germany
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Palenčár D, Švec A. [Vascularised Fibula and Tendon Transfer in the Comprehensive Treatment of Forearm Fracture with Gas Gangrene Complication]. Acta Chir Orthop Traumatol Cech 2019; 86:290-293. [PMID: 31524592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.
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Affiliation(s)
- D Palenčár
- Klinika plastickej, rekonštrukčnej a estetickej chirurgie Lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice Bratislava
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Kuo YR, Chen CC, Wang JW, Chang JK, Huang YC, Pan CC, Lin YC, Wu RW, Lee CH. Bone infarction of the hip after hand allotransplantation: A case report. Microsurgery 2018; 39:349-353. [PMID: 30481394 DOI: 10.1002/micr.30375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 11/07/2022]
Abstract
Vascularized composite allotransplantation represents as an emerging field in reconstructive surgery. However, some complications can be associated with the procedure. The authors describe a case of bone infarctions of the bilateral hip joints following the first hand allotransplantation in Taiwan. A 45-year-old man who experienced a traumatic amputation of the distal third of his forearm received a hand transplantation from a brain-dead donor. Immunosuppression included antithymocyte globulins, and bolus methylprednisolone (Solu-Medrol) was used for the induction. The maintenance therapy protocol included systemic tacrolimus, mycophenolate mofetil, and prednisone. The patient discontinued the systemic steroid 15 months after surgery. Two episodes of acute rejections were observed at 105 and 810 days after surgery. These signs disappeared after pulse therapy with Solu-Medrol, titration with tacrolimus, and topical immunosuppressive creams (tacrolimus and clobetasol). However, the patient felt pain in both hips after long periods of standing 30 months after the transplantation. A pelvic radiograph and magnetic resonance imaging revealed avascular necrosis (AVN) in both hip joints. Because of the progressive worsening of the pain, the patient underwent a decompression surgery on the left hip involving a fibula bone graft. The patient underwent a right hip hemi-arthroplasty with a bipolar prosthesis 3 months later. The patient remained in good health without major complications. These findings indicate that systemic steroids and tacrolimus might be the major predisposing factors for the induction of AVN after hand allotransplantation.
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Affiliation(s)
- Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chien-Chang Chen
- Department of Plastic & Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jun-Wen Wang
- Orthopedics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jui-Kun Chang
- Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Chung Pan
- Pharmacology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Lin
- Department of Plastic & Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Re-Wen Wu
- Orthopedics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abstract
OBJECTIVES To describe a midshaft forearm fracture pattern that places the ulnar nerve at risk in the pediatric population and provide 7 clinical case examples describing the injury pattern and treatment methods. DESIGN Retrospective observational case series, review of literature, cadaver dissection, and treatment recommendations. SETTING Multi-institutional, Southeast United States. PATIENTS Seven pediatric patients (5 male and 2 female) with mean age of 8.7 years (range, 3-14) who sustained a significantly displaced closed, or grade I open, middle to distal one-third both-bone forearm fracture with subsequent ulnar nerve dysfunction. INTERVENTIONS Manual reduction and casting of both-bone forearm shaft fractures, operative debridement, fracture fixation, nerve exploration, neurolysis, nerve repair, and nerve grafting. MAIN OUTCOME MEASUREMENTS Radiographic fracture union, clinical ulnar nerve motor and sensory function testing, along with selective electric nerve testing and advanced imaging were monitored throughout follow-up postinjury. RESULTS Five of 7 patients underwent surgical treatment and 2 others were treated with conservative measures. The ulnar nerve was entrapped within the fracture site of one patient with an open fracture along with partial nerve transection, and 4 patients were found to have the nerve encased in hypertrophic scar tissue or bony callus upon surgical exploration at 3-12 months postinjury. CONCLUSIONS The ulnar nerve lies in a precarious position in the middle to distal one-third forearm and is bound by anatomic constraints that place the nerve at risk of injury. This article offers a treatment algorithm that includes conservative treatment, acute exploration, early exploration (≤3 months), and late exploration (>3 months). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew E Federer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Joshua S Murphy
- Department of Orthopedics, Atlanta Medical Center, Atlanta, GA
| | | | | | | | | | - Gary M Lourie
- The Hand and Upper Extremity Center of Georgia, Atlanta, GA
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Abstract
RATIONALE Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient. PATIENT CONCERNS Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury. DIAGNOSES X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location. INTERVENTIONS The foreign body was removed completely following a microsuture of the cephalic vein. OUTCOMES The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up. LESSONS This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area
| | - Maohua Wei
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of General Surgery, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning, China
| | - Ze Song
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Liang Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of General Surgery, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning, China
| | - Jifeng Fan
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Mozhen Liu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian
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Liu G, Ma W, Li M, Feng J, Xu R, Pan Z. Operative treatment of terrible triad of the elbow with a modified Pugh standard protocol: Retrospective analysis of a prospective cohort. Medicine (Baltimore) 2018; 97:e0523. [PMID: 29668642 PMCID: PMC5916669 DOI: 10.1097/md.0000000000010523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to investigate the efficacy of the surgical treatment of terrible triad injuries of the elbow using a modified standard surgical approach, and treatment determined by the mode and mechanism of injury, and intraoperative findings.The study was a retrospective analysis of a prospective cohort of patients presenting with terrible triad injuries of the elbow, who underwent surgical treatment between July 2009 and January 2014. All patients were treated surgically according to a modified Pugh standard protocol. Elbow functional status and range of movements were evaluated at 3 months, 6 months, 1 year, and 2 years or more after surgery. Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.Our series included a final cohort of 29 males and 13 females with a mean age of 48.23 ± 10.95 years at the time of injury. The mean follow-up period was 30.47 ± 7.65 months. The mean flexion-extension arc was 107° ± 22°, and the average forearm rotation arc was 145° ± 14°. The mean Mayo Elbow Performance Score was 88 ± 10 points (range 55 to 100 points), with excellent results in 24 elbows, good results in 16, and poor results in 2. Functional results of the elbow improved significantly from 3 months postoperatively (P < .05), but tended to plateau from 1 year after surgery. Thirteen patients had radiographic signs of arthrosis (9 grade 1, 4 grade 2). Postoperative complications were local infection around the incision (n = 1), transient postoperative median nerve paralysis (n = 1), and postoperative posterior interosseous nerve paralysis (n = 1). Four patients required further surgery. Five patients had evidence of heterotopic ossification.Overall, we show that slight modifications to Pugh standard protocol for the surgical treatment of terrible triad injuries can lead to good to excellent results, although there were a good number of complications. The ideal surgical approach and treatment should be based on the mode and mechanism of injury, and intraoperative findings, and modifying the standard surgical treatment approach for terrible triad elbow injuries may be beneficial.
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Affiliation(s)
- Guanyi Liu
- Department of Orthopedics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
- Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China
| | - Weihu Ma
- Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China
| | - Ming Li
- Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China
| | - Jianxiang Feng
- Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China
| | - Rongming Xu
- Department of Orthopedics, Ningbo 6th Hospital, Ningbo, Zhejiang, P.R. China
| | - Zhijun Pan
- Department of Orthopedics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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Baldwin PC, Han E, Parrino A, Solomito MJ, Lee MC. Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures. Orthopedics 2017; 40:e849-e854. [PMID: 28776629 DOI: 10.3928/01477447-20170719-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the rate of cast-related complications when using split or intact casts. A total of 60 patients aged 3 to 13 years with closed shaft or distal third radius and ulna fractures requiring reduction were recruited for this study. Patients underwent closed reduction under sedation and were placed into a long-arm fiberglass cast with 1 of 3 modifications: no valve, univalve, or bivalve. Patients were followed to 6 weeks after reduction or surgical treatment if required. The frequency of neurovascular injury, cast saw injury, unplanned office visits, and cast modifications, the need for operative intervention, and pain levels through the follow-up period were recorded. The results showed no incidents of compartment syndrome or neurovascular injury. Additionally, there were no differences between complications associated with cast type (P=.266), frequency of cast modifications (P=.185), or subsequent need for surgical stabilization (P=.361). Therefore, cast splitting following closed reduction of low-energy pediatric forearm fractures does not change clinical outcomes with respect to neurovascular complications, cast modifications, pain levels, or the need for repeat reduction. Consideration should be given to minimizing cast splitting after reduction of low-energy pediatric forearm fractures for practice efficiency and to potentially decrease saw-related injury. [Orthopedics. 2017; 40(5):e849-e854.].
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Gendelberg D, Hennrikus WL, Sawyer C, Armstrong D, King S. Decreased Radiation Exposure Among Orthopedic Residents Is Maintained When Using the Mini C-Arm After Undergoing Radiation Safety Training. Orthopedics 2017; 40:e788-e792. [PMID: 28598494 DOI: 10.3928/01477447-20170531-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
The resident curriculum of the American Board of Orthopaedic Surgery emphasizes radiation safety. Gendelberg showed that, immediately after a program on fluoroscopic safety, residents used less radiation when using the mini C-arm to reduce pediatric fractures. The current study evaluated whether this effect lasted. Residents underwent a new annual 3-hour session on mini C-arm use and radiation. Group A included 53 reductions performed before training. Group B included 45 reductions performed immediately after training. Group C included 46 reductions performed 11 months later. For distal radius fractures, exposure time and amount were 38.1 seconds and 83.1 mR, respectively, for group A; 26.7 seconds and 32.6 mR, respectively, for group B; and 24.1 seconds and 40.0 mR, respectively, for group C. When radiation time and amount were compared between group B and group C, P values were .525 and .293, respectively. When group C and group A were compared, P values were <.05 and <.01, respectively. For both bone forearm fractures, exposure time and amount were 41.2 seconds and 90.9 mR, respectively, for group A; 28.9 seconds and 30.4 mR, respectively, for group B; and 31.2 seconds and 43.6 mR, respectively, for group C. When radiation time and amount were compared between group B and group C, P values were .704 and .117, respectively. When group C and group A were compared, P values were .183 and .004, respectively. No significant difference in radiation exposure was noted immediately after training vs 11 months later. A sustained decrease in radiation exposure occurred after an educational program on safe mini C-arm use. [Orthopedics. 2017; 40(5):e788-e792.].
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Andaloussi S, Amine Oukhouya M, Alaoui O, Atarraf K, Chater L, Afifi MA. [Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases]. Pan Afr Med J 2017; 27:68. [PMID: 28819489 PMCID: PMC5554682 DOI: 10.11604/pamj.2017.27.68.11058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 05/01/2017] [Indexed: 12/15/2022] Open
Abstract
This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.
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Affiliation(s)
- Saad Andaloussi
- Service de Traumato-Orthopédie Pédiatrique, CHU Hassan II, Fès, Maroc
| | | | - Othmane Alaoui
- Service de Traumato-Orthopédie Pédiatrique, CHU Hassan II, Fès, Maroc
| | - Karima Atarraf
- Service de Traumato-Orthopédie Pédiatrique, CHU Hassan II, Fès, Maroc
| | - Lamiae Chater
- Service de Traumato-Orthopédie Pédiatrique, CHU Hassan II, Fès, Maroc
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Jordan RW, Aquilina A, Westacott DJ, Cooke S. A comparison of ketamine sedation and general anaesthesia for manipulation of paediatric forearm fractures. Acta Orthop Belg 2016; 82:836-842. [PMID: 29182126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the study was to compare the use of ketamine sedation and general anaesthesia for manipulation of paediatric wrist and forearm fractures. A retrospective analysis was performed of patients under 16 years treated at our centre between October 2014 and October 2015. Exclusion criteria were open fractures and fractures with complete displacement. Outcomes measured were fracture reduction, the quality of the cast, fracture redisplacement, further surgical intervention and use of theatre time. 66 children were manipulated over the study period; 31 received ketamine sedation and 35 general anaesthesia. No statistically significant difference was found in the rate of re-intervention (p=0.48), quality of reduction (p=0.39), quality of cast (p=0.14 and p=0.21), or redisplacement (p=0.87). Those undergoing general anaesthesia used on average 50 minutes of theatre time and one third required an overnight admission. We conclude that ketamine sedation achieves comparable treatment outcomes to general anaesthesia whilst using fewer resources.
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Kailis V, Hariga H, Docquier PL. Prevention of re-fractures of both bones of the forearm in children. Acta Orthop Belg 2016; 82:872-875. [PMID: 29182132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The aim of this study was to observe if the re-fracture rate after forearm both bones was decreased by protecting the forearm with a preventive brace for 6 months following the fracture and by ceasing all physical activities. METHODS We performed a retrospective study in 75 consecutive cases of diaphyseal fracture of both bone of forearms, in 52 boys and 23 girls aged from 6 months to 11 years. It concerned a first episode of fracture in 84% of cases and a re-fracture in 17%. RESULTS Re-fracture rate was 0% in the group where a protective brace was worn while it was 20% in the group without brace. CONCLUSIONS Both the wearing of a protective brace and absence of sport for 6 months may decrease the re-fracture rate to 0%, if the patient is compliant by wearing it and by ceasing all physical activities.
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