Related Experiment Videos
[Elastic stable intramedullary nailing of hand bones. ECMES even with the hand]
S Lallemand1, A de Jesse Levas
1Clinique ambulatoire, centre médical de Mamao BP 141008, 98701 Arue, Polynésie française. slallemand@cmm.pf
Insights
Elastic intra-medullary nailing (ECMES) is effective for hand bone fractures in children. This technique promotes rapid functional recovery with minimal scarring, making it suitable for diaphyseal, metaphyseal, and epiphyseal fractures.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Context:
- Traditional methods for hand fractures can lead to complications like scarring and adhesions.
- Elastic intra-medullary nailing, a technique developed by Metaizeau for pediatric femur fractures, has not been widely applied to hand bone fixation.
- Evaluating the efficacy of ECMES for hand fractures is crucial for improving pediatric orthopedic practices.
Purpose:
- To assess the applicability and outcomes of elastic intra-medullary nailing (ECMES) for treating fractures of the bones of the hand in children.
- To evaluate the effectiveness of ECMES in achieving bone union and functional recovery.
- To compare the results of ECMES with traditional fixation methods in terms of complications and patient outcomes.
Summary:
- A retrospective review of 43 pediatric patients with hand fractures treated with ECMES between 1995 and 1999 was conducted.
- Bone fixation was achieved using single or double pre-stressed pins, with material removal varying from 35 days to 4.5 months.
- Forty-eight patients achieved complete recovery of joint range of motion, with minimal complications reported, including one skin necrosis, one delayed healing, one infection, and one mal-union.
Impact:
- ECMES is suitable for diaphyseal, metaphyseal, and epiphyseal fractures of the hand bones.
- The technique's minimally invasive nature results in reduced scarring and adhesions.
- ECMES facilitates rapid functional recovery, offering a promising alternative for pediatric hand fracture management.
Aim:
Apply the principles of elastic intra-medullary nailing developed by Metaizeau for children, to bone fixation of bones of the hand.
Method:
Retrospective review of 43 patients treated between 1995 and 1999 for fracture of one or more bones of the hand. Thirty five concerned the right hand, 11 the left; 54 involved metacarpal fractures and 2 fractures of the phalanx. Only those patients whose lesions were considered mended were taken into account in this study.
Results:
In 32 cases, bone fixation was completed with the use of a single pre-stressed pin, in 24 cases 2 prestressed pins forming a double arc were used. The delay in removal of material varied from between 35 days to 4 1/2 months. In three cases it required a dynamic splint treatment. Functional re-education was prescribed for two patients. Eight patients were lost for follow up. Fourty eight were followed with complete recovery of joint range of motion. We deplored one necrosis of the skin due to the contusion at the time of the initial trauma, one delayed healing after an animal bite required keeping the material in place for 4 months, one case of infection; in another case insufficient stabilization by the ECMES resulted in a 10 degrees mal-union of the metacarpal diaphysis. Three times the site of a fracture had to be opened in order to perform bone fixation.
Conclusion:
The ECMES appears perfectly suitable for bone fixation of the diaphysis of bones of the hand and certain metaphyseal and epiphyseal fractures. Small incisions help to avoid unbecoming scars and adhesions and foster a rapid recovery of function.