[Percutaneous osteosynthesis of childhood fractures]

Percutaneous osteosynthesis in child traumatology is no new issue. It has been used for half a century in the treatment of supracondylar fractures of the humerus. With improvement of X-ray amplifiers and osteosynthetic materials its use can be, however, substantially extended and it can be considered one of the surgical methods for the treatment of fractures in children. For osteosynthesis most frequently a Kirschner wire is used, however, also a wire with a fine thread can be used, various types of intramedullary implanted rods, screws of different dimensions and modern absorbable materials. The prerequisite of percutaneous osteosynthesis is the possibility of successfully performed manual reduction of the fragments under X-ray control, anatomical access to the percutaneous introduction of suitable implants and a type of fracture where the fragments can be sufficiently stabilised by the selected material. For operation in addition to an X-ray amplifier suitable implants are needed, and frequently, e.g. in intramedullary fixations, also special instruments. The advantage of percutaneous osteosynthesis is slight devastation of soft tissues, in particular periarticular structures, slight exposure of the site of fracture to possible infection. This results in safer and more rapid healing and restored function as compared with open reduction. The main disadvantage of the percutaneous method is greater exposure of the patient, and in particular the surgical team, to X-ray radiation. Percutaneous osteosynthesis can be used in indicated cases at many different sites in fractures of long and short bones of the child skeleton.