S2113 IM NAILING IN FOREARM SHAFT FRACTURES AND RADIAL NECK FRACTURES IN CHILDREN

Abstract

For a long time treatment of all forarm fractures was coservatively in principle. Retrospective analysis of more than 1000 fractures showed that 97,8% were treated orthopedically, 22% finished consolidation with an axial malalignment of more than 10∞ and 6,9% showed bad functional results 3–13 years later. Most bad results were found in shaft fractures of both bones on the same level or in oblique fractures with convergent displacement.

The introduction of elastic stable intramedullary nailing (ESIN) gave the opportunity to stabilize instable diaphy-seal fractures with less [Aufwand], with an implant adequate for children and with the possibility of immediate postoperative movement. Within three years, 161 diaphy-seal forearm fractures were managed by cast (27%), reduction (32%) or osteosynthesis (41%). In 14 cases (8,7%), secondary osteosynthesis took place because of secondary or re-displacement during orthopedic treatment. The functional results following ESIN are very good.

In radial neck fractures with severe displacement of more than 60° an open reduction and fixation by K-wires was the preferred method for a long time. After open reduction, radial head necrosis was the result in a significant part of cases independent of the quality of reduction. Closed reduction with the tip of the nail without touching the fracture region improved the results extremely. Seldom a transcapsular reduction manoever is necessary.

In a multicentric study of proximal radius fractures including 67 cases, 27 fractures with a relevant displacement were managed surgically (24 ESIN, 3 K-wire). 3 [Verplumpung] of the radial head, two of them combined with premature closure of epiphyseal plate, and one radial head necrosis took place, but only in one case with ESIN, whereas all cases with open reduction and K-wire use showed problems during the healing course.