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Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases.

Abstract Elastic stable intramedullary nailing (ESIN) has been established as state of the art treatment for forearm fractures in children, if operative stabilization is required. Their use has been expanded to single bone shaft fractures, and also more complex injuries such as Monteggia fractures or Monteggia-like lesions. A wide range of complications has been reported in the literature, up to 70% in certain investigations. The purpose of this study was to assess the complication rate after ESIN treatment of forearm fractures in children and adolescents in a representative cohort of patients from a level 1 trauma center in Germany.Between 2000 and 2015, we retrospectively analyzed all patients, up to the age of 16 years, with forearm fractures, who were operatively treated using ESIN in our department of general and trauma surgery. The main outcome measurements were the rates of postoperative complications after ESIN such as re-fracture, malunion, nonunion, tendon lesion, wound infection, and limited range of motion.In all, 201 consecutive patients with 202 forearm fractures were included in this study. Age averaged 9.7 years (range 3-16 years). Fifteen (7.4%) fractures were open. Fractures were 82.2% diaphyseal both-bone forearm fractures. Follow-up averaged 10.2 months (range 0.7-176.3 months). Complications were 10 re-fractures, 2 malunions, 3 extensor pollicis longus tendon ruptures, 1 superficial wound infection, and 2 limited range of motions. Fourteen (6.9%) children required a secondary operative intervention for their complication. Time to implant removal averaged 3.8 months (range 0.4-16.3 months).Elastic stable intramedullary nailing is a minimally invasive and reliable technique with a low complication rate. Both-bone forearm fractures and single bone fractures, and also Monteggia and Monteggia-equivalent fractures can be successfully treated with this method. As a major complication, re-fractures are frequently seen, even with ESIN in situ.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422876
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Low complication rate of elastic stable intramedullary nailing (ESIN) of
      pediatric forearm fractures: A retrospective study of 202 cases.
PG  - e6669
LID - 10.1097/MD.0000000000006669 [doi]
AB  - Elastic stable intramedullary nailing (ESIN) has been established as state of the
      art treatment for forearm fractures in children, if operative stabilization is
      required. Their use has been expanded to single bone shaft fractures, and also
      more complex injuries such as Monteggia fractures or Monteggia-like lesions. A
      wide range of complications has been reported in the literature, up to 70% in
      certain investigations. The purpose of this study was to assess the complication 
      rate after ESIN treatment of forearm fractures in children and adolescents in a
      representative cohort of patients from a level 1 trauma center in Germany.Between
      2000 and 2015, we retrospectively analyzed all patients, up to the age of 16
      years, with forearm fractures, who were operatively treated using ESIN in our
      department of general and trauma surgery. The main outcome measurements were the 
      rates of postoperative complications after ESIN such as re-fracture, malunion,
      nonunion, tendon lesion, wound infection, and limited range of motion.In all, 201
      consecutive patients with 202 forearm fractures were included in this study. Age 
      averaged 9.7 years (range 3-16 years). Fifteen (7.4%) fractures were open.
      Fractures were 82.2% diaphyseal both-bone forearm fractures. Follow-up averaged
      10.2 months (range 0.7-176.3 months). Complications were 10 re-fractures, 2
      malunions, 3 extensor pollicis longus tendon ruptures, 1 superficial wound
      infection, and 2 limited range of motions. Fourteen (6.9%) children required a
      secondary operative intervention for their complication. Time to implant removal 
      averaged 3.8 months (range 0.4-16.3 months).Elastic stable intramedullary nailing
      is a minimally invasive and reliable technique with a low complication rate.
      Both-bone forearm fractures and single bone fractures, and also Monteggia and
      Monteggia-equivalent fractures can be successfully treated with this method. As a
      major complication, re-fractures are frequently seen, even with ESIN in situ.
FAU - Kruppa, Christiane
AU  - Kruppa C
AD  - aDepartment of General and Trauma Surgery, BG-University Hospital Bergmannsheil
      Bochum, Ruhr-University Bochum bDepartment of Orthopaedics and Trauma Surgery,
      University Hospital Essen, Germany.
FAU - Bunge, Pamela
AU  - Bunge P
FAU - Schildhauer, Thomas A
AU  - Schildhauer TA
FAU - Dudda, Marcel
AU  - Dudda M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006669 [doi]
AID - 00005792-201704210-00057 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6669. doi: 10.1097/MD.0000000000006669.

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