Complications and Outcomes of Diaphyseal Forearm Fracture Intramedullary Nailing: A Comparison of Pediatric and Adolescent Age Groups

被引:0
作者
Martus, Jeffrey E. [1 ]
Preston, Ryan K. [2 ]
Schoenecker, Jonathan G. [1 ]
Lovejoy, Steven A. [1 ]
Green, Neil E. [1 ]
Mencio, Gregory A. [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Orthopaed & Rehabil, Monroe Carrell Jr Childrens Hosp, Nashville, TN 37232 USA
[2] Med Univ S Carolina, Charleston, SC 29425 USA
关键词
pediatric; adolescent; forearm fracture; intramedullary nailing; complication; outcome; SHAFT FRACTURES; COMPARTMENT SYNDROME; FIXATION; ELBOW; CHILDREN; MOTION; RANGE; EXPERIENCE; RADIUS; JOINTS;
D O I
暂无
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Flexible intramedullary nailing (IMN) has become a popular technique for the management of unstable or open forearm fractures. Recent publications have suggested an increased incidence of delayed union and poor outcomes in older children and adolescents. The objective of this study was to review forearm fractures treated with IMN, comparing the rate of complications and outcomes between the 2 age groups. Our hypothesis was that IMN is an effective technique with a similar rate of complications in both age groups. Methods: An Institutional Review Board-approved retrospective review was conducted of pediatric forearm fractures treated from 1998 to 2008 at a single institution. Over the study time period, 4161 pediatric forearm fractures were managed non-operatively (92%) and 353 were treated operatively with plate, cross-pin, or intramedullary fixation (8%). Patients with inadequate follow-up, cross-pin, or plate fixation were excluded. Medical records were reviewed for indications and complications. Complications were graded with a modification of the Clavien-Dindo classification. Outcomes were judged by a new grading system. Results: A total of 205 forearm fractures treated with IMN in 203 patients were identified. The mean age was 9.7 years (range, 1.7 to 16.2 y) and mean follow-up was 42 weeks. Operative indications were failure of closed treatment in 165 (80%) and open fracture in 40 (20%). Mean time from injury to IMN was 5.9 days (range, 0 to 25 d). Single bone IMN was performed in 40 of 185 both bone fractures (26%); there were 20 single-bone forearm fractures treated with IMN. Open reduction was required in 61/165 (37%) of closed fractures. Asymptomatic delayed union (grade 1 complication) was observed in 9 fractures (4%). More severe complications were noted in 17% (grade 2 to 4 complications). Postoperative compartment syndrome occurred in 3 isolated forearm fractures with a significant younger mean age (6.0 vs. 10 y, P = 0.031). Overall, complications were significantly more frequent in children older than 10 years of age (25/101) as compared with younger children (13/104, P = 0.031). In particular, delayed union was more common in children over the age of 10 years (9/101 vs. 1/104, OR = 9.99, P = 0.009). Outcomes were good or excellent in 91% of fractures. There was no statistical association of patient age with a fair or poor outcome. Conclusions: IMN is an effective technique for pediatric forearm fractures with good to excellent outcomes in 91%. Complications are not infrequent with this technique, with complications of grade 2 to 4 severity in 17%. There was a 2-fold increase in the rate of complications in children over the age of 10 years. Compartment syndrome was more common in younger children. Patients and families should be counseled about the risks preoperatively.
引用
收藏
页码:598 / 607
页数:10
相关论文
共 41 条
  • [1] AMIT Y, 1985, J PEDIATR ORTHOPED, V5, P143
  • [2] Blakemore LC, 2000, CLIN ORTHOP RELAT R, P32
  • [3] NORMAL RANGE OF MOTION OF JOINTS IN MALE-SUBJECTS
    BOONE, DC
    AZEN, SP
    [J]. JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1979, 61 (05) : 756 - 759
  • [4] The Clavien-Dindo Classification of Surgical Complications Five-Year Experience
    Clavien, Pierre A.
    Barkun, Jeffrey
    de Oliveira, Michelle L.
    Vauthey, Jean Nicolas
    Dindo, Daniel
    Schulick, Richard D.
    de Santibanes, Eduardo
    Pekolj, Juan
    Slankamenac, Ksenija
    Bassi, Claudio
    Graf, Rolf
    Vonlanthen, Rene
    Padbury, Robert
    Cameron, John L.
    Makuuchi, Masatoshi
    [J]. ANNALS OF SURGERY, 2009, 250 (02) : 187 - 196
  • [5] Severity Grading of Surgical Complications
    Clavien, Pierre A.
    Strasberg, Steven M.
    [J]. ANNALS OF SURGERY, 2009, 250 (02) : 197 - 198
  • [6] Complications of intramedullary fixation of pediatric forearm fractures
    Cullen, MC
    Roy, DR
    Giza, E
    Crawford, AH
    [J]. JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1998, 18 (01) : 14 - 21
  • [7] Paediatric forearm fractures: the increasing use of elastic stable intra-medullary nails
    Cumming, D.
    Mfula, N.
    Jones, J. W. M.
    [J]. INTERNATIONAL ORTHOPAEDICS, 2008, 32 (03) : 421 - 423
  • [8] DARUWALLA JS, 1979, CLIN ORTHOP RELAT R, P114
  • [9] Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey
    Dindo, D
    Demartines, N
    Clavien, PA
    [J]. ANNALS OF SURGERY, 2004, 240 (02) : 205 - 213
  • [10] Nonunion of forearm shaft fractures in children after intramedullary nailing
    Fernandez, Francisco F.
    Eberhardt, Oliver
    Langendoerfer, Micha
    Wirth, Thomas
    [J]. JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, 2009, 18 (06): : 289 - 295