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Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications
Brian A Kelly1, Patricia Miller, Benjamin J Shore
1Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
Insights
Comparing buried versus exposed intramedullary implants for pediatric forearm fractures shows no significant difference in infection, refracture, or overall complication rates. This finding aids surgical decision-making for pediatric fracture fixation.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Pediatric forearm fractures are common injuries requiring surgical intervention.
- Intramedullary fixation is a common surgical technique for these fractures.
- Implant placement (buried vs. exposed) is a surgical consideration with potential implications for complications.
Purpose of the Study:
- To compare complication rates between buried and exposed intramedullary implants in pediatric forearm fracture fixation.
- To evaluate differences in refracture, infection, and overall complication rates based on implant placement.
- To identify factors predicting complications in pediatric forearm fractures treated with intramedullary fixation.
Main Methods:
- Retrospective comparative cohort study of 339 children with displaced forearm fractures treated between 2004 and 2009.
- Patients were divided into groups based on whether intramedullary implants were buried or exposed.
- Data analyzed included demographics, injury characteristics, surgical technique, and postoperative complications.
Main Results:
- No significant differences were observed in refracture rates (3.1% vs. 7.0%), infection rates (3.5% vs. 2.3%), or overall complications (14.5% vs. 17.2%) between buried and exposed implant groups.
- Buried implants were associated with a higher rate of skin penetration (3.9%).
- Injury to the dominant arm and the need for open reduction were significant predictors of complications.
Conclusions:
- The method of intramedullary implant placement (buried or exposed) does not significantly impact the rates of infection, refracture, or overall complications in pediatric forearm fractures.
- Surgical decisions regarding implant placement can be made without significant concern for differential complication rates.
- Further research may explore strategies to mitigate complications associated with buried implants, such as skin penetration.
Background:
The purpose of this study was to compare the rate of complications between buried and exposed intramedullary implants after fixation of pediatric forearm fractures.
Methods:
A retrospective comparative cohort study of 339 children treated with intramedullary fixation for displaced forearm fractures between 2004 and 2009 was performed. Implants were left exposed in 128 patients (37.8%) and buried beneath the skin in 208 patients (61.4%); 3 patients had buried and exposed hardware (0.9%). Data on demographics, injury, surgical technique, and complications were analyzed.
Results:
The buried implant group was older (mean 10.3 vs. 8.5 y; P < 0.001), heavier (mean 38.6 vs. 31.9 kg; P < 0.001), and had fewer open injuries (23% vs. 41%; P < 0.001) than the exposed implant group. The buried group had their implants removed later than the exposed group (median 3.5 vs. 1.2 mo; P < 0.001). There was no difference between time to removal for patients with refracture and those without (median 1.3 vs. 2.0 mo; P = 0.78). A total of 36.2% of exposed implants were successfully removed in the office. Complications were seen in 56 patients (16.5%). There were 16 patients (4.7%) with refracture and 12 patients (3.5%) with infection. The buried and exposed implant groups did not differ significantly with respect to refracture (3.1% vs. 7.0%; P = 0.20), infection (3.5% vs. 2.3%; P = 0.66), or overall complications (14.5% vs. 17.2%; P = 0.87). There was also no difference between groups with respect to loss of reduction, nondelayed or delayed union, loss of motion, hypertrophic granuloma, or tendon rupture. Buried implants were also associated with penetration through the skin (3.9%). Injury to the dominant arm and need for open reduction were significant predictors of complication (OR = 1.01; 95% CI, 1.001-1.012; P = 0.02 and OR = 0.51; 95% CI, 0.264-0.974; P = 0.04, respectively).
Conclusions:
There were no significant differences seen in number of infections, refractures, or overall complications based on whether implants were left exposed or buried beneath the skin after surgery.
Level Of Evidence:
Level III, therapeutic.
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