İntramedüller K-Teli Tespiti: Pediatrik Distal Radius Kırıklarının Tedavisinde Uygulanabilir ve Etkin Bir Teknik

Bu çalışmada, deplase distal metafizyal ve diametafizyal radius kırıkğı olan 6 çocuğun tedavisinde uyguladığımız intramedüller K-teli tespitinin, klinik ve radyolojik sonuçlarını sunmayı amaçladık. Çalışmaya Ocak 2016-Haziran 2017 tarihleri arasında anstabil distal radius kırığı tanısı ile polikliniğe başvuran 6 çocuk hasta dahil edildi. Ortalama yaş 8 (dağılım 7-9) idi. Hastaların 3'ünde kırıklar 1.5-2 mm çapında perkütan uygulanan K-teli ile transepifizyal, diğerlerinde ise hem transepifizyal hem de transkortikal tespit edildi. Cerrahi sonrası kısa dönem takip sonuçları değerlendirildi. Ortalama ameliyat süresi 20 dakika idi (dağılım 15-25). Tüm vakalarda ameliyat sonrası 3 hafta boyunca ek olarak kısa kol splint kullanıldı. Tüm vakalarda 6 hafta sonra K-telleri çıkarıldı. Hastaların tümünde kemik kaynamasına ortalama 4 haftada (dağılım 3-6) ulaşıldı. Ortalama 13 aylık takipte (dağılım 4-18), malunion veya distal radiusun erken epifizyal kapanmasını da içeren herhangi bir komplikasyon saptanmadı. Bu çalışmanın sonuçları, çocuklarda deplase radius distal kırıklarının perkütan olarak fleksible intramedüller K-teli tespit tekniği ile redüksiyonunun ve osteosentezinin, stabil yapının korunması konusunda kolay, minimal invazif ve hızlı uygulama gibi birçok avantajı olduğunu göstermiştir. Bu yöntemin pediatrik distal anstabil radius kırıklarında güvenilir bir tedavi seçeneği olduğu açıktır.

Anahtar Kelimeler:

Anstabil Radius Kırığı, İntramedüller Tespit, Pediatrik

Intramedullary K-Wire Fixation: A Feasible and Effective Technique in Treatment of Pediatric Distal Radius Fractures

In this research we aimed to report the clinical and radiological results of a retrospective study performed on 6 children with severely displaced distal radial metaphyseal and diametaphyseal fractures, who were treated with percutaneous intramedullary Kischner wire (K-wire) fixation. A total of 6 children with distal unstable radius fractures, all of whom have visible physeal plate, were treated as an inpatient at our clinic January 2016 to June 2017. The average age was 8 years (range, 7–9 years). The fractures were fixed with two percutaneous intramedullary K-wires of 1.5-2 mm in diameter either transepiphyseally in three of them or both transepiphyseally and transcortically in the remaining three. Operative and short follow-up outcomes were assessed. The average operation time was 20 min (range, 15-25 min). Additional below-the-elbow splint was used in all cases for 3 weeks postoperatively. K-wires were removed after 6 weeks in all cases. Bone union was achieved at an average time of 4 weeks (range, 3-6 weeks) in all cases. No complication including malunion or early epiphyseal closure of the distal radius was identified at mean follow-up of 13 months (range, 4-18 months). Results of this study showed that reduction and osteosynthesis of distal displaced radius fractures in children by percutaneous flexible intramedullary K-wire fixation technique have many advantages regarding the maintenance of the stable construct with easy, minimally invasive and quick application. We thought that this method is a reliable treatment option for pediatric distal unstable radius fractures.

Keywords:

Intramedullary Fixation, Pediatric, Unstable Radius Fracture,

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1. Eichinger JK, Agochukwu U, Franklin J, Arrington ED, Bluman EM. A new reduction technique for completely displaced forearm and wrist fractures in children: a biomechanical assessment and 4-year clinical evaluation. J Pediatr Orthop. 2011;31(7):73-9.
2. Parikh SN, Jain VV, Youngquist J. Intrafocal pinning for distal radius metaphyseal fractures in children. Orthopedics. 2013;36(6):783-8.
3. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005; 25:490-4.
4. Walton NP, Brammar TJ, Hutchinson J, et al. Treatment of unstable distal radial fractures by intrafocal, intramedullary K-wires. Injury. 2001;32:383–9.
5. Flisch CW, Della Santa DR. Osteosynthesis of distal radius fractures by flexible intramedullary nailing (Geneva experience). Chir Main. 1998;17:245–54.
6. Bukvić N, Marinović M, Bakota B, et al. Complications of ESIN osteosynthesis--Experience in 270 patients. Injury. 2015;46(6):40-3.
7. Letts M, Rowhani N. Galeazzi-equivalent injuries of the wrist in children. J Pediatr Orthop. 1993;13(5):561-6.
8. McLauchlan GJ, Cowan B, Annan IH, Robb JE. Management of completely displaced metaphyseal fractures of the distal radius in children. J Bone Joint Surg. 2002;84B:413–7.
9. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg. 2010; 20:395–8.
10. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005; 25:490–4.
11. Kapandji A. Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius. Ann Chir. 1976;30:903–8.
12. Sano K, Hashimoto T, Kimura K, Ozeki S. Percutaneous flexible double pinning (Py-Desmanet's procedure) for pediatric distal radius fractures. Hand (N Y). 2013;8(4):392-6.
13. Illing P, Lascombes P. Case collection of forearm fractures. In: Dietz HG, Schmittenbecher PP, Slongo T, Wilkins E, editors. Elastic stable intramedullary nailing (ESIN) in children (AO manual of fracture management series). New York: Thieme; 2006: 71–108.
14. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg. 2014;99:269–75.
15. Joulié S, Laville JM, Salmeron F. Posteromedial elastic stable intra-medullary nailing (ESIN) in volarly displaced metaphyso-diaphyseal distal radius fractures in child. Orthop Traumatol Surg Res. 2011;97:330–4.
16. Varga M, Józsa G, Fadgyas B, Kassai T, Renner A. Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation. Medicine (Baltimore). 2017;96(14):e6532.
17. Desmanet E. Osteosynthesis of the radius by double elastic springpinning. Functional treatment of the distal end fracture of the radius. A study of 130 cases. Ann ChirMain. 1989;8:193–206.
18. Py C, Churet JP. Tentative de mobilisation immediate des fractures de l’extrémité inférieure de radius. Personal communication, Tours and Western Center Surgical Society Meeting, 18 June, 1969.
19. Abzug JM, Little K, Kozin SH. Physeal arrest of the distal radius. J Am Acad Orthop Surg. 2014;22:381–9.
20. Boyden EM, Peterson HA. Partial premature closure of the distal radial physis associated with Kirschner wire fixation. Orhopedic. 1991;14:585–8.