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A modified Kapandji procedure for Smith's fracture in children
J M Guichet1, C C Moller, G Dautel
1Children's Hospital, Vandoeuvre-Lès-Nancy, France.
Insights
This study modified the Kapandji technique for treating wrist fractures by using a posterior pin approach, reducing neurovascular risks. The modified method effectively stabilized anteriorly displaced distal radial fractures in children, allowing a return to full activity.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Fracture management
Background:
- Anteriorly displaced wrist fractures require effective reduction and stabilization.
- The traditional Kapandji technique uses an anterior approach for percutaneous intrafocal pinning.
- Potential risks include neurovascular damage with the anterior approach.
Purpose of the Study:
- To modify the Kapandji technique for treating distal radial fractures with anterior displacement.
- To evaluate the safety and efficacy of a posterior approach for percutaneous intrafocal pinning.
- To assess anterior fracture stabilization and patient outcomes in pediatric cases.
Main Methods:
- A modified Kapandji technique involving posterior percutaneous intrafocal pinning was employed.
- Six children with distal radial fractures exhibiting anterior displacement or instability were treated.
- Fracture reduction and stabilization were achieved through the posterior pin insertion.
Main Results:
- The modified posterior approach successfully achieved good anterior stabilization of the distal radial fractures.
- No neurovascular complications were reported in the treated pediatric patients.
- Pins were removed at an average of eight weeks, with patients returning to full activity.
Conclusions:
- The modified Kapandji technique with a posterior approach offers a safe and effective alternative for treating anteriorly displaced distal radial fractures in children.
- This method minimizes the risk of neurovascular injury compared to the traditional anterior approach.
- It is a viable option for unstable fractures, especially after failed conservative treatment or in bilateral adolescent fractures.
Abstract:
Anteriorly displaced fractures of the wrist can be treated by the Kapandji technique of percutaneous intrafocal pinning with pins inserted through an anterior approach to give good reduction and stabilisation of the fracture. We have modified this technique by placing the pins through a posterior approach which decreases the risks of neurovascular damage. We have used this method to treat six children with distal radial fractures showing anterior displacement or instability. Good anterior stabilisation was achieved. The pins were removed at an average of eight weeks and the patients were then able to return to full activity. This simple technique can be used for unstable fractures after the failure of conservative treatment or in bilateral fractures in adolescents.