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Comparison of Percutaneous Intramedullary Pin Fixation and Elastic Stable Intramedullary Nails for Pediatric Forearm
Alyssa Basdavanos1, Matthew B Holloway2, Trinity A Kronk3
1Department of Orthopedic Surgery, Harbor - UCLA (University of California, Los Angeles) Medical Center, Torrance, USA.
Insights
Percutaneous pinning (PIP) is a cost-effective option for pediatric forearm fractures, offering shorter operative times and avoiding surgical removal compared to elastic stable intramedullary nails (ESINs). This method reduces costs without compromising clinical outcomes or increasing complications.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Fracture management
Background:
- Percutaneously placed intramedullary pin fixation offers potential benefits for pediatric forearm fractures.
- Physicians have concerns regarding clinical outcomes of percutaneous intramedullary pinning (PIP) versus traditional surgical management.
- Elastic stable intramedullary nails (ESINs) are a common surgical approach for pediatric forearm fractures.
Purpose of the Study:
- To analyze operative time, clinical outcomes, and costs of PIP compared to ESINs in pediatric forearm fracture surgery.
- To evaluate patient satisfaction with PIP removal.
Main Methods:
- Single-center, retrospective comparative study of pediatric patients (≤18 years) with forearm fractures treated with PIP or ESINs.
- Analysis of operative times, treatment outcomes, complications, unplanned reoperations, and cost data.
- Prospective phone survey for patient satisfaction with PIP removal.
Main Results:
- PIP patients were significantly younger (6.2 vs 11.9 years).
- PIP operative time was 40 minutes shorter than ESIN (p<0.001).
- No significant differences in fracture healing, complications, range of motion, or reoperations.
- Implant charges for ESIN were 10.5 times higher than PIP ($598 vs $52).
- 100% of PIP patients surveyed preferred outpatient removal; elective ESIN removal cost $10,836 (±3,891).
Conclusions:
- Percutaneous pinning is a cost-efficient alternative to ESIN for diaphyseal forearm fractures in young pediatric patients.
- PIP technique avoids surgical implant removal, decreases operative time, and significantly reduces costs.
- PIP does not increase complications or reoperations compared to ESIN.
Introduction:
Percutaneously placed intramedullary pin fixation poses potential benefits to the patient in the treatment of pediatric forearm fractures; however, physicians still have concerns regarding clinical outcomes in comparison to traditional surgical management. The purpose of this study is to analyze the operative time, clinical outcomes, and costs associated with percutaneous intramedullary pinning (PIP) compared with elastic stable intramedullary nails (ESINs) in pediatric patients undergoing surgery for forearm fractures.
Materials And Methods:
In this single-center, retrospective comparative study, patients ≤18 years old with forearm fractures requiring surgical intervention with either PIP or ESINs were included. Operative times, treatment outcomes, complications, unplanned reoperations, and cost data were analyzed. A prospective phone survey was also conducted for patient satisfaction with PIP removal in the outpatient setting.
Results:
A total of 140 patients were included in this study (26 PIP, 114 ESIN). PIP patients were significantly younger than ESIN patients (6.2 vs 11.9 years, p<0.001). After accounting for single- versus both-bone fixation, PIP operative time was 40 minutes shorter than that for ESIN (p<0.001). There was no statistically significant difference between the groups in fracture healing, complications, range of motion, or unplanned reoperations. Of the 38% (n=10) of PIP patients who responded to the phone survey, 100% preferred outpatient removal. Implant charges were 10.5 times higher for ESIN patients compared to PIP ($598 vs $52). There were no charges for outpatient pin removal in the postoperative global period, whereas elective ESIN removal in the OR had a mean charge of $10,836 (±3,891).
Conclusions:
Our study supports the use of percutaneous pinning as a cost-efficient alternative to ESIN for diaphyseal forearm fractures in young pediatric patients with a mean age of six years. This technique avoids the need for surgical implant removal, decreases operative time, and significantly reduces costs without increasing complications or reoperations.
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