Abstract
Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures.» (Flynn et al.). In the Paediatric Surgery Department biodegradable pins of solid polydioxanone (PDS) in management of paediatric fractures have been used since April 1986. PDS pins are too soft for the osteosynthesis in fractures with fragments under high tensile pressures. However, we have successfully carried out a large number of internal fixations in children’s elbows. This is based on accurate distribution of PDS pins and careful positioning of periostal sutures and the adjacent disrupted muscles. Our technique, as presented at the 2nd European Congress of Paediatric Surgery in Madrid in 1997, is to fix temporarily the repositioned fractured fragment with Kirschner’s metal wire. Following osteosynthesis with PDS, the protruding K-wire is left in place for seven days until the limb is safely immobilized.
A total of 96 patients were operated. The purpose of the study is to compare osteosynthesis with PDS pins (Group A) with that of metallic K-wire (Group B). Each group consisted of 48 children. General characteristics (age, sex, and fracture types) were statistically the same (P > 0.05). In Group A, with children between 2 and 13 years, or 9.3 on average, 21 children were with the lateral condyle fractures (43.75%), 25 children with medial epicondyle fractures (52.08%), and 2 children with medial condyle fractures (4.16%). In Group B, with children between 2 and 14 years, or 8.7 on average, 26 children were with lateral condyle fractures (54.16%), 19 children with medial epicondyle fractures (39.58%), and 3 with medial condyle fractures (6.25%). The study excludes Milch Type II fractures of medial and lateral condyles. The results have been examined in the follow-up period of one, three, and six months of two different methods according to Flynn’s criteria. After statistical evaluation the differences obtained had no statistical significance (P > 0.05). However, satisfaction score (0 – 10) is significantly higher in Group A than in Group B for both parents and evaluators (P < 0.05). Both treatments exhibit good results with the exception that the use of metal osteosynthetic material requires another operation. If metal wires are used and cut just underneath the skin, protruding with local inflammation may appear. Proper use of PDS pins requires no further operation. This is to the benefit for both the patient and rehabilitation staff.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
