Related Experiment Videos
Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children
S D Shoemaker1, C P Comstock, S J Mubarak
1Department of Orthopedic Surgery, Children's Hospital, San Diego, California 92123, USA.
Insights
Standard intramedullary Kirschner wires (K-wires) effectively treat open or unstable pediatric forearm fractures when conservative methods fail. Burying K-wires and stabilizing both radius and ulna can minimize complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Open or unstable diaphyseal forearm fractures in children pose treatment challenges.
- Closed management may fail, necessitating surgical intervention.
- Intramedullary Kirschner wires (K-wires) are a potential treatment option.
Purpose of the Study:
- To evaluate the efficacy and complication profile of standard intramedullary K-wires for pediatric diaphyseal forearm fractures.
- To identify factors contributing to complications and suggest technique refinements.
Main Methods:
- Retrospective review of 32 children with open or unstable diaphyseal forearm fractures treated with K-wires.
- Mean follow-up of 13 months.
- Analysis of fracture healing, range of motion, and complication rates.
Main Results:
- Excellent or good results in all 32 patients.
- Average time to bridging cortex was 3 months.
- Four patients had limited pronation/supination; no growth-plate arrest.
- Nine complications in eight patients, including lost reduction and infections.
Conclusions:
- Intramedullary K-wire fixation with cast immobilization is effective for problematic pediatric forearm fractures unresponsive to closed management.
- Burying K-wires and stabilizing both radius and ulna are recommended to potentially avoid complications like infection and lost reduction.
Abstract:
This retrospective review evaluates the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of open or unstable diaphyseal forearm fractures in 32 children with a mean follow-up of 13 months. Thirty-one patients had an excellent result, and one patient had a good result. Average time to bridging cortex was 3 months. Four patients lacked full pronation and supination, with none lacking >20 degrees, and no patients had evidence of growth-plate arrest. Nine complications occurred in eight patients: lost reduction after K-wire removal (three), refracture (two), deep infection (one), pin-site infection (one), transient anterior interosseous nerve palsy (one), and skin ulcer over buried K-wire (one). Both infections occurred in cases in which the K-wire ends were left outside the skin. Each case of lost reduction occurred in single-bone fixation cases when the K-wires were removed before 4 weeks. In children, intramedullary fixation by using standard K-wires plus cast immobilization provides effective treatment for the problematic open or unstable diaphyseal forearm fracture when closed management has failed. Refinement of the technique may help to avoid complications. We now recommend burying the K-wires under the skin for 3-5 months and stabilizing both the radius and ulna with an intramedullary K-wire.