Fixation of forearm fractures with intramedullary k-wire or elastic nail by fluoroscopy in children and radiation exposure

Aim: To show midterm results and compare the two methods utilized in pediatric forearm fractures fixation and the risks of radiation.Material and Methods: We conducted retrospective studies of 62 children and adolescent between the age of 6 to 16 years who were exposed to traumatic forearm fractures and treated with methods of fixation mini open reduction and intramedullary K-wire pinning(group 1) and close reduction and intramedullary elastic nailing(group 2). Patient data included age, gender, the mechanismsof injury, fluoroscopic screening time, dose area product (DAP) value, union time, duration of hospitalization, and complications.Results: There was a significant difference in radiation exposure and radiation-related cancer risk in group 2 (P

PDF

___

1. Parajuli NP, Shrestha D,Dhoju D, et al . Intramedullary nailing for pediatric diaphyseal forearm bone fracture. Kathmandu Univ Med J 2011;9:198-202.
2. Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6493 fractures. J Paediatr Orthop 1999;19:344-50.
3. Flynn JM , Kristofer JJ, Matthew RG, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop 2010; 30:313-9.
4. O'Rourke PJ, Crerand S, Harrington P, Casey M, Quinlan W. Risks of radiation exposure to orthopaedic surgeons. J R Coll Surg Edinb 1996;41:40-3.
5. JK Jain, RK Sen, SC Bansal. Image intensifier and the orthopedic surgeon. Ind J Orthop 2001;35:13-9.
6. Rajesh KB, Sharon G, Meghann O, et al. Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine 2008;9:570-3.
7. William FM, Joseph PD, Mark IK, et al. Genomic instability induced by ionizing radiation. Radiat Res 1996;146:247-58.
8. Amit Y, Salai M, Chechik A, et al. Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report. J Pediatr Orthop 1985;5:143146.
9. Austin H , Dawn Gl, Matthew B, et al. Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures.J Orthop Trauma 2017; 31:334-8.
10. Slongo TF, Audigé L, AO. Pediatric Classification Group Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF) J Orthop Trauma 2007;21:135-60.
11. Joost WC , Jan HA , Max R , et al. Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study. Injury 2014;45:696-700.
12. Gustilo RB, Simpson L, Nixon R, Ruiz A, Indeck W. Analysis of 511 open fractures. Clin Orthop Relat Res 1969;66:148-54.
13. Price CT , Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990; 10:705-12.
14. Reza F , Harlan MK, Yongfei W, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;36:849-57.
15. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007;37:1-332.
16. United Nations Scientific Committee on the Effects of Atomic Radiatio Sources and Effects of Ionizing Radiation, UNSCEAR 2013 Report to the General Assembly, with Scientific Annexes. New York, NY: United Nations Publications 2013.
17. Huda W. Kerma-area product in diagnostic radiology. AJR 2014;203:565-9.
18. Andreassi MG, Ait-Ali L, Botto N, et al. Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease. Eur Heart J. 2006;27:2703-8.
19. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Nuclear and Radiation Studies Board, Division on Earth and Life Studies. National Research Council of the National Academies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academies Press; Washington, DC: 2006.
20. Veiga LH, Holmberg E, Anderson H, et al. Thyroid cancer after childhood exposure to external radiation: an updated pooled analysis of 12 studies. Radiat Res 2016;185:473-84.
21. Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 2006;36:121-5.
22. Giuseppe C , Fernando DM, Federico M, et al. Physeal fractures of the distal radius and ulna: long-term prognosis. J. Orthop. Trauma 2003;17:172-9.
23. Shirzad H , Anette KH, Morten SL, et al. Remodeling of Salter-Harris type II epiphyseal plate injury of the distal radius. J Pediatr Orthop 2004;24:472-6.
24. Boyden EM, Peterson HA. Partial premature closure of the distal radial physis associated with Kirschner wire fixation. Orthopedics 1991;14:585-8.
25. Jeremy TS, James R, Waters PM. The Effect of Pinning Across the Physis for Stabilization of Fractures in Children: An MRI Evaluati on https://pdfs. semanticscholar.
26. Dokmeci MO, Kalender AM, Sevimli R, et al. The effect of ibandronate on fracture healing in rat tibia model. SM J Orthop 2016; 2:1041.
27. Heare A, Dawn G, Matthew B, Corey Beebe, et al. Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures. J Orthop Trauma 2017; 31:334-8.
28. Calder PR, P Achan, M Barry. Diaphyseal Forearm Fractures in Children Treated With Intramedullary Fixation: Outcome of K-wire Versus Elastic Stable Intramedullary Nail. Injury 2003;34:278-82.
29. Qidwai SA. Treatment of Diaphyseal Forearm Fractures in Children by Intramedullary Kirschner Wires. J Trauma 2001;50:303-7.
30. Yung PS, Lam CY, Ng BK, et al. Percutaneous transphyseal intramedullary Kirschner wire pinning:a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children..J Pediatr Orthop. 2004;24:7-12.
31. Makki D, Kheiran A, Gadiyar R, et al. Refractures following removal of plates and elastic nails from paediatric forearms.J Pediatr Orthop B. 2014; 23:221-6.