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Percutaneous Kirschner-wire fixation for displaced distal forearm fractures in children
Mohamed F Mostafa1, Gamal El-Adl, Ahmed Enan
1Department of Orthopaedic Surgery and Traumatology, Mansoura University Hospital, Mansoura, Egypt. thabetortho20032003@yahoo.com
Insights
Percutaneous Kirschner-wire fixation is effective for high-risk pediatric distal forearm fractures. This method achieved satisfactory results in 87.5% of cases, indicating its clinical utility.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Distal forearm fractures are common in children.
- High-risk fractures require effective management to prevent long-term complications.
- Percutaneous Kirschner-wire fixation is a minimally invasive technique.
Purpose of the Study:
- To evaluate the efficacy of percutaneous Kirschner-wire fixation for high-risk pediatric distal forearm fractures.
- To assess clinical and radiological outcomes.
- To identify factors associated with unsatisfactory results.
Main Methods:
- Prospective study of 32 children (average age 10.1 years) with displaced distal forearm fractures.
- Management involved closed reduction and percutaneous Kirschner-wire fixation.
- Follow-up averaged 28.6 months with clinical and radiological evaluations.
Main Results:
- Satisfactory results were achieved in 87.5% of cases.
- Antegrade intramedullary Kirschner-wire fixation was used in 71.9% of distal radial fractures.
- Residual angulation and limited forearm rotation correlated with unsatisfactory outcomes.
Conclusions:
- Percutaneous Kirschner-wire fixation is a safe and effective treatment for high-risk pediatric distal forearm fractures.
- Primary fixation supplemented with cast immobilization is recommended.
- Minimizing residual angulation is crucial for optimal functional recovery.
Abstract:
A prospective study was conducted to evaluate the efficacy of percutaneous Kirschner-wire fixation for the management of high-risk distal forearm fractures in children. Thirty two children (22 boys & 10 girls) with displaced fractures of the distal third of the radius with or without ulnar fractures were managed by closed reduction and percutaneous Kirschner-wire fixation. Their average age was 10.1 years (4-16 years). The fracture was open (Grade 1) in two cases (6.3%). Antegrade intramedullary Kirschner-wire fixation was done for distal radial fractures in 71.9% of cases. Patients were evaluated clinically and radiologically after an average duration of follow-up of 28.6 months. Patients with residual angulation more than 15 degrees, limitation of forearm or wrist movement more than 20 degrees, persistent pain or clinical deformity were considered to have unsatisfactory results. Satisfactory results were obtained in 87.5% of all cases. The residual radioulnar and dorsovolar angulations were significantly related to the decrease in forearm rotation and the unsatisfactory results. High-risk distal forearm fractures in children should be treated by primary percutaneous Kirschner-wire fixation supplemented by cast immobilisation.
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