A NEW MINI-INVASIVE TECHNIQUE IN TREATING PEDIATRIC DIAPHYSEAL FOREARM FRACTURES BY BIOABSORBABLE ELASTIC STABLE INTRAMEDULLARY NAILING: A PRELIMINARY TECHNICAL REPORT
A NEW MINI-INVASIVE TECHNIQUE IN TREATING PEDIATRIC DIAPHYSEAL FOREARM FRACTURES BY BIOABSORBABLE ELASTIC STABLE INTRAMEDULLARY NAILING: A PRELIMINARY TECHNICAL REPORT
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DOI：
10.1177/1457496913490459
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发表时间：
2013-12-01
影响因子：
2.4
通讯作者：
Merikanto, J.
中科院分区：
文献类型：
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作者：
Sinikumpu, J. -J.;Keranen, J.;Merikanto, J.
背景和目的：儿童前臂骨干不稳定骨折通常需要手术治疗。近年来，微创复位和弹性稳定髓内钉取代了切开复位和钢板内固定，受到越来越多的关注。金属髓内植入物有几个缺点，例如软组织刺激和干扰后期成像的风险。因此，它们通常在以后的操作中被移除。目的：探讨可吸收髓内钉固定儿童前臂骨折的新技术。材料与方法：采用二期微创手术技术固定儿童不稳定性前臂骨折。该方法为生物可吸收弹性稳定髓内钉。我们研制了聚丙交酯-乙交酯超高强度生物可吸收髓内钉。这种材料已被广泛证明具有足够的生物相容性和稳定性，可以作为螺钉和钉子进行骨折治疗。我们将这一新技术应用于5-15岁儿童不稳定双骨干前臂骨折的治疗。我们在这三个病例的系列中报告了这项技术和我们的临床经验，这些病例已经被随访至少12个月。对于钛弹性稳定髓内钉，本系列已被随机分组，该系列代表了正在进行的随机试验的一部分。结果：报道的新技术操作的病例骨折愈合良好，随访时对位可接受。不需要取出植入物。没有注意到手术或种植体本身的问题，表明有很好的可行性。1例高能再骨折发生在初次创伤后半年。结论：采用可吸收弹性稳定髓内钉固定儿童前臂不稳定性骨折的微创手术方法，取得了初步经验。我们的临床经验表明，长臂石膏结合手术治疗儿童前臂骨折是可行的。这项技术可能会给处理这些具有挑战性的骨折带来好处。金属植入物的缺点可以避免。此外，将不需要移除植入物。在这一系列中有一次再次骨折，但这是由于新的高能创伤。根据我们的了解，它与既往接骨术的类型无关。然而，忽略了良好的初步经验，我们仍然没有得出该方法相对于传统弹性稳定髓内钉的优越性的结果。我们正在进行的随机多中心研究旨在根据目前的黄金标准确定其长期结果。然而，由于初步结果令人鼓舞，我们认为有必要报告这项技术。
Background and Aim: Operative treatment is often indicated in unstable pediatric diaphyseal forearm fractures. Recently minimally invasive reduction and elastic stable intramedullary nailing have been of increasing interest, instead of open reduction and internal fixation with plates. There are several disadvantages of metallic intramedullary implants, such as soft-tissue irritation and a risk of disturbing later imaging. Thus, they are generally removed in later operations. We aimed to develop a new technique to stabilize pediatric forearm fractures by the bioabsorbable intramedullary nailing.Material and Methods: We developed a new, two-stage mini-invasive surgical technique to stabilize the unstable diaphyseal fractures in children. The procedure is bioabsorbable elastic stable intramedullary nailing. Ultra-high-strength bioabsorbable intramedullary nails of poly(lactide-co-glycolide) were manufactured for our purpose. The material has been widely proven to be biocompatible and stable enough for fracture treatment as screws and pins. We have used the new technique in the unstable both-bone diaphyseal forearm fractures in children between the ages of 5 and 15 years. We report the technique and our clinical experience in the series of those three cases that have been followed up for at least 12 months. The present series has been randomized for the procedure instead for titanium elastic stable intramedullary nailing, and the series represents a part of ongoing randomized trial.Results: The reported cases operated by the new technique referred good union in the fractured bones and acceptable alignment in the follow-up. Removal of the implants was not required. No troubles with the procedure or implant per se were noticed, indicating good feasibility. One high-energy refracture occurred half year after the primary trauma. Traditional titanium implants were used to control the refracture.Conclusions: We report our preliminary experience of a new surgical mini-invasive procedure to stabilize the unstable pediatric forearm shaft fractures by bioabsorbable elastic stable intramedullary nailing. Our clinical experience suggests that the procedure combined with long-arm casting is feasible in treating the pediatric forearm fractures. The technique may bring benefits to handling these challenging fractures. The disadvantages of metallic implants may be avoided. In addition, removal of the implant will not be required. There was one refracture in the series, but it was due to new high-energy trauma. According to our understanding, it was not related to the type of former osteosynthesis. However, ignoring the good preliminary experience, still we do not have results of the superiority of the procedure over traditional elastic stable intramedullary nailing. Our ongoing randomized multicenter study is aimed to determine its long-term outcome against the present golden standard. Nevertheless, due to encouraging preliminary results, we see it necessary to report the technique.