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Review paper

The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment

By
Salvatore Di Giacinto Orcid logo ,
Salvatore Di Giacinto
Contact Salvatore Di Giacinto

Department of Pediatrics Orthopedics and Traumatology, Meyer University Children's Hospital, Florence , Florence , Italy

Giuseppe Pica ,
Giuseppe Pica

Department of Orthopedics and Traumatology, AORN San Pio , Benevento , Italy

Alessandro Stasi ,
Alessandro Stasi

Department of Orthopedics and Traumatology, Santissima Annunziata Hospital , Taranto , Italy

Lorenzo Scialpi ,
Lorenzo Scialpi

Department of Orthopedics and Traumatology, Santissima Annunziata Hospital , Taranto , Italy

Alessandro Tomarchio ,
Alessandro Tomarchio

Department of Orthopedics and Traumatology, S. Croce e Carle Cuneo Hospital , Cuneo , Italy

Alberto Galeotti ,
Alberto Galeotti

Orthopaedic Traumatology Centre, Careggi University Hospital , Florence , Italy

Vlora Podvorica ,
Vlora Podvorica

Pediatric Orthopedic and Trauma Unit, University Clinical Center , Prishtina , Kosovo*

Annamaria dell’Unto ,
Annamaria dell’Unto

Department of Orthopedics, Sapienza, University of Roma La Sapienza , Rome , Italy

Luigi Meccariello
Luigi Meccariello

Department of Orthopedics and Traumatology, AORN San Pio , Benevento , Italy

Abstract

Aim
Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/forearm fracture.
Methods
A total of 43 patients who presented with distal radius/forearm fractures were enrolled and divided into two groups: 23
patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS).
Results
In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third
month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05).
Conclusion
The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician
is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference.
The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.

References

1.
Patel S, Anthony S, Zurakowski D, Didolkar M, Kim P, Wu J, et al. Radiographic scoring system to evaluate union of distal radius fractures. J Hand Surg Am. 2014;1471–9.
2.
Schneidmüller D, Röder C, Kraus R, Marzi I, Kaiser M, Dietrich D, et al. Development and validation of a paediatric long-bone fracture classification. A prospective multicentre study in 13 European paediatric trauma centres. BMC Musculoskelet Disord. 2011;89.
3.
Zimmermann R, Gabl M, Angermann P, Lutz M, Reinhart C, Kralinger F, et al. Late sequelae of fractures of the distal third of the forearm during the growth period. Handchir Mikrochir Plast Chir. 2000;242–9.
4.
Lee B, Esterhai J, Jr, Das M. Fracture of the distal radial epiphysis. Characteristics and surgical treatment of premature, post-traumatic epiphyseal closure. Clin Orthop Relat Res. 1984;90–6.
5.
Sengab A, Krijnen P, Schipper I. Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis. Eur J Trauma Emerg Surg. 2020;789–800.
6.
Sengab A, Krijnen P, Schipper I. Displaced distal radius fractures in children, cast alone vs additional K-wire fixation: a meta-analysis. Eur J Trauma Emerg Surg. 2019;1003–11.
7.
Baldwin K, Morrison M, Tomlinson L, Ramirez R, Flynn J. Both bone forearm fractures in children and adolescents, which fixation strategy is superior -plates or nails? A systematic review and meta-analysis of observational studies. J Orthop Trauma. 2014;8-e14.
8.
Carmichael K, English C. Outcomes assessment of pediatric both-bone forearm fractures treated operatively. Orthopedics. 2007;379–83.
9.
Fernandez F, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing. Injury. 2005;1210–6.
10.
Reinhardt K, Feldman D, Green D, Sala D, Widmann R, Scher D. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop. 2008;403–9.
11.
Hedström E, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents: increased incidence over the past decade: a population-based study from northern Sweden. Acta Orthopaedica. 2010;148–53.
12.
Calori G, Colombo M, Mazza E, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone nonunions. Injury. 2014;(Suppl 6):93–7.
13.
Joeris A, Lutz N, Blumenthal A, Slongo T, Audigé L. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop. 2017;129–32.
14.
Cha S, Shin H. Buttress plating for volar Barton fractures in children: Salter-Harris II distal radius fractures in sagittal plane. J Pediatr Orthop B. 2019;73–8.
15.
Freese K, Faulk L, Palmer C, Baschal R, Sibbel S. A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures. Injury. 2018;2053–7.
16.
Akar D, Köroğlu C, Erkus S, Turgut A, Kalenderer Ö. Conservative follow-up of severely displaced distal radial metaphyseal fractures in children. Cureus. 2018;3259.
17.
Akar D, Köroğlu C, Erkus S, Turgut A, Kalenderer Ö. Conservative follow-up of severely displaced distal radial metaphyseal fractures in children. Cureus. 2018;3259.
18.
Schneidmueller D, Kertai M, Bühren V, Von Rüden C. Kirschner wire osteosynthesis for fractures in childhood: bury wires or not? Results of a survey on care reality in Germany. Unfallchirurg. 2018;817–21.
19.
Handoll H, Elliott J, Iheozor-Ejiofor Z, Hunter J, Karantana A. Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 2018;
20.
Karl J, Olson P, Rosenwasser M. The epidemiology of upper extremity fractures in the United States. J Orthop Trauma. 2009;242–4.

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