Wang Wei,Xu Wenqiang,Liu Chaoyu,et al.Clinical application of modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for children with Judet Ⅳ radial neck fracture[J].Journal of Clinical Pediatric Surgery,,20():766-772.[doi:10.12260/lcxewkzz.2021.08.012]
Clinical application of modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for children with Judet Ⅳ radial neck fracture
- Keywords:
- Radial Neck Fracture; Percutaneous Prying Reduction; Elastic Intramedullary Nail; Fracture Fixation; Child
- CLC:
- R683.415;R726.8
- Abstract:
- Objective To explore the feasibility and early clinical outcome of applying modified Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nail for Judet Ⅳ radial neck fracture in children. Methods From April 2019 to October 2020, retrospective analysis was performed for 23 children with Judet Ⅳ radial neck fracture. There were 15 boys and 8 girls with an age range of 5-14 years. Time from injury to operation was 1-4 days. The involved side was left (n=13) and right (n=10). There were simple radius neck fractures (n=15), proximal ulnar fractures (n=7) and concurrent fracture of internal humeral epicondyle (n=1). According to the Judet classification scheme, the clinical types were Ⅳa (n=15) and Ⅳb (n=8). The degree of displacement was 82.3°(72°-90°). Operative duration, number of fluoroscopy, and frequency of reduction were recorded. The quality of reduction was evaluated according to Metaizeau radiological standards during the last follow-up. Flexion of elbow joint and rotation of forearm at both sides were recorded and statistical analysis was performed. Results The average operative duration was 22 min, the average number of reductions 1.3(1-3) and the average number of fluoroscopy 7.2 (5-12). According to the Metaizeau radiological standard, the outcomes were excellent (n=21) and decent (n=2). Elbow joint and forearm rotation function exercises were performed after long-arm plaster fixation for 3-4 weeks. Nail was extracted after satisfactory healing at Month 2-5 post-operation. The average follow-up period was 10.5(4-21) months. At the last follow-up, elbow joint was evaluated by the Metaizeau’s criteria. The outcomes were excellent (n=22) and decent (n=1). The ranges of flexion, extension, pronation and supination of affected side were (141.09ed ges of flexion, extension, pron, 86.269ed ges) versus those of healthy side (141.83th flexion, exte. 27°, 86.13°±1.42°, 86.83°±1.72°). The differences were not statistically different (P>0.05). During follow-ups, there was no occurrence of infection, fracture displacement, bone nonunion, malunion, cross union, premature closure of epiphysis or radial nerve injury. Conclusion The modified approach of Kirschner wire percutaneous rotation prying reduction plus elastic intramedullary nailing is efficacious for children with severely displaced radial neck Judet Ⅳ fractures. It offers the advantages of convenient material supply, simple handling, easier "capturing" of obviously displaced radial head, faster precision reduction, lowered radiation exposure, fewer complications and satisfactory immediate efficacies.
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Memo
收稿日期:2021-02-25。
基金项目:安徽省阜阳市自筹经费科技计划项目（编号：FK202081026）
作者简介:王伟,Email:fywangwei0558@163.com