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COMPARATIVE ANALYSIS OF TREATMENTS FOR FOREARM FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Airton Pereira da Costa1, Erika Tonarelli Rodrigues1, Hassan Ahmad Hauache1
1Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Departamento Ortopedia e Traumatologia, Sao Paulo, SP, Brazil.
Insights
This systematic review compared intramedullary fixation methods for pediatric forearm fractures. While TEN rods and Kirschner wires reduced surgical time, they also increased adverse events, necessitating careful treatment selection.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Evidence-Based Medicine
Background:
- Forearm fractures are common in children, requiring effective surgical fixation.
- Intramedullary fixation using TEN rods or Kirschner wires are common surgical options.
- Clinical outcomes and complication rates vary between fixation methods.
Purpose of the Study:
- To systematically review and compare clinical outcomes of intramedullary fixation with TEN rods versus Kirschner wires in pediatric forearm fractures.
- To assess adverse events, surgical time, and fracture consolidation time.
- To provide evidence for optimal treatment selection in pediatric forearm fractures.
Main Methods:
- Systematic literature review across Pubmed/Medline, Science Direct, and Scielo databases.
- Quality assessment of included trials using the MINORS tool.
- Meta-analysis of data from 16 selected studies (1,075 patients) using R software.
Main Results:
- Meta-analysis showed a significant increase in adverse events with TEN rods compared to Kirschner wires (RR 1.35).
- Surgical time was significantly reduced with TEN rods (mean difference -12.42 to -21.62 minutes).
- Fracture consolidation time showed a non-significant increase with TEN rods (mean difference 0.99). Moderate to high heterogeneity was observed (I² 73%).
Conclusions:
- Intramedullary fixation with TEN nails and Kirschner wires yields diverse clinical outcomes and complication profiles.
- The choice of fixation method requires careful consideration of patient-specific factors and fracture characteristics.
- Further research may be needed to clarify optimal fixation strategies given observed heterogeneity.
Abstract:
To compare the clinical outcomes of children with forearm bone fractures undergoing surgical treatment with intramedullary fixation with TEN rods and Kirschner wires. A systematic review of the literature was carried out, conducting a search for data in the Pubmed/Medline, Science Direct and Scielo databases. The quality of the trials was assessed by the MINORS tool and the meta-analysis of the studies was performed using the R software (version 4.4.0). 16 studies were selected, representing 1,075 patients, with a predominance of males, where the mean age range varied from 8.32 to 14.2 years. Applying the MINORS Scale, the quality of the studies was good (≥ 11). The meta-analysis of the studies revealed a statistically significant increase in the risk of adverse events in the experimental group compared to the control group, with a risk ratio (RR) of 1.35 (95% CI: 1.03 to 1.76). The combined mean difference (raw mean) between the experimental group and the control group was -12.42 minutes (95% CI: -13.75 to -11.10) in the fixed-effect model, indicating a significant reduction in surgical time for the experimental group. In the random-effect model, the mean difference was -21.62 minutes (95% CI: -33.30 to -9.94). Regarding fracture consolidation time, the fixed-effect model indicated a raw mean difference of 0.99 (95% CI: 0.61 to 1.36). Furthermore, heterogeneity was moderate to high, with an I² of 73% (p < 0.01). Intramedullary fixation with TEN nails and Kirschner wires presents a diversity of clinical outcomes and complications. The systematic review highlighted the importance of choosing the appropriate treatment method, considering the patient characteristics and the nature of the fracture. Level of Evidence II; Systematic Review .
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