[Miniinvasive osteosynthesis of upper extremity fractures in children.]

Over the period of 1994-1998 a total of 1,955 therapeutic surgeries in treating fractures under general anesthesia were carried out in the Pediatric Trauma Center in Brno. Of these 1,311 operations were performed in a conservative manner (67%) and 644 operations (33%) were carried out with the use of oseosynthetic material. Open reduction and fixation were performed in 121 cases (6.2%), including external fixations. Miniinvasive osteosynthesis -MIO was used in 523 cases (26.8%), of that 388 times on the upper extremity reaching 74.1% of the total number of osteosyntheses performed using this method. Short incision was carried out 19 times due to inability to perform conservative reduction of fragments, mostly in fractures of both forearm bones in the diaphyseal area. The most frequently used material was Kirschner wires - 341 times (87.8%), followed by a Prevot wire 24 times (6.2%), a FFS screw 13 times (3.5%) and absorbable implant in 10 cases (2.5%). Extraction of the material was performed based on the fracture type between 3rd and 5th weeks, mostly under general anesthesia. Indication of supracondylar fractures of the humerus (39.9%) prevailed on the extremity followed by fractures of both forearm bones (12.1%) and fractures of the proximal metaphysis of the humerus (9.5%). In 139 cases (35.8%) it was indicated after primarily carried our conservative reduction failed. Failure of MIO were observed in indicating on the upper extremity in five cases (1.3%). Four times after the treatment of supracondylar fractures of the humerus and in one case after percutaneous pinning of the injured apophysis of the medial epicondyle. All of them were managed by percutaneous pin retransfixation. Complications occurred in 18 cases (4.6%). If correctly indicated and correctly technically performed MIO represents a reliable method, complementing the treatment of a conservative method or replacing open techniques in the ever increasing indications. Its main advantage is prevention of redisplacement of a fracture and significant comfort of the patient. Key words: miniinvasive osteosynthesis, upper extremity, fractures, children.