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Pediatric forearm fractures with in situ intramedullary implants.

Kelly BA, Shore BJ, Bae DS, Hedequist DJ, Glotzbecker MP - J Child Orthop (2016)

Bottom Line: The remaining five patients (83 %) returned to the operating room for treatment.All patients went on to uncomplicated radiographic union at a mean 3.6 months.This rare complication can be treated by several different methods, including revision TENS placement, revision to plate fixation, or in situ bending of rods, with the expectation for successful uncomplicated union.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.

ABSTRACT

Purpose: The purpose of this investigation is to present our institutional experience with fractures of the pediatric forearm with in situ intramedullary nails.

Methods: Six patients treated at our institution for forearm fracture with in situ intramedullary implants between 2004 and 2013 were reviewed. Patient demographics, injury and radiographic characteristics, method of treatment, time to union, and complications were collected from the medical record.

Results: 485 patients with forearm fractures were treated with intramedullary implants and six patients presented with a fracture with in situ implants (1.2 %). Fractures in all six patients resulted from a second traumatic event after radiographic healing but before implant removal at a mean of 13.0 months from the initial procedure. One patient had an adequately aligned fracture and was treated with casting without reduction. The remaining five patients (83 %) returned to the operating room for treatment. Two patients underwent rod removal and placement of new intramedullary implants, and two patients were treated with rod removal and plating without attempt at closed reduction. One patient underwent closed reduction in the operating room with successful re-bending of the radial implant and replacement of the ulna implant. All patients went on to uncomplicated radiographic union at a mean 3.6 months.

Conclusions: The incidence of fracture of pediatric forearm with in situ intramedullary implants is low. This rare complication can be treated by several different methods, including revision TENS placement, revision to plate fixation, or in situ bending of rods, with the expectation for successful uncomplicated union.

No MeSH data available.


Related in: MedlinePlus

Anteroposterior (a) and lateral (b) radiographs of a 6 year old girl (Patient 1) who sustained a refracture after a trip and fall. She was treated with rebending of the radial implant and removal and replacement of the ulnar implant (c, d)
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Fig1: Anteroposterior (a) and lateral (b) radiographs of a 6 year old girl (Patient 1) who sustained a refracture after a trip and fall. She was treated with rebending of the radial implant and removal and replacement of the ulnar implant (c, d)

Mentions: The remaining five patients (83 %) had unacceptable alignment of their fractures and returned to the operating room for a second surgical procedure. One patient (Patient 6) had an attempt at closed reduction under conscious sedation in the emergency department due to concern for skin tenting, but had continued unacceptable alignment of the fracture. The remaining four patients were taken to the OR without an attempt at closed reduction in the emergency room due to surgeon preference. One patient (Patient 1, Fig. 1) had successful closed bending of the radial implant under general anesthesia in the OR with residual deformity of the ulnar implant and subsequent replacement of the ulnar implant. Two patients (Patients 3, 4) had removal of their intramedullary implants with replacement of new nails (Patient 3, Fig. 2). Patient 3 had an attempt at closed reduction in the OR prior to implant exchange with continued unacceptable alignment and underwent single bone fixation of the ulna with acceptance of the residual radial deformity because of the patient’s age. Patient 4 underwent replacement without an attempt at closed reduction. One patient (Patient 2, Fig. 3) had removal of nails with plate osteosynthesis because of his age and skeletal maturity utilizing stacked 1/3rd tubular plates for both the radius and ulna and one patient (Patient 6) with stacked 1/3rd tubular plates for the ulna and 3.5 mm LC-DCP plate for the radius (Synthes, West Chester, PA ). Patients 2 and 6 did not undergo an attempt at closed reduction prior to plating.Fig. 1


Pediatric forearm fractures with in situ intramedullary implants.

Kelly BA, Shore BJ, Bae DS, Hedequist DJ, Glotzbecker MP - J Child Orthop (2016)

Anteroposterior (a) and lateral (b) radiographs of a 6 year old girl (Patient 1) who sustained a refracture after a trip and fall. She was treated with rebending of the radial implant and removal and replacement of the ulnar implant (c, d)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940241&req=5

Fig1: Anteroposterior (a) and lateral (b) radiographs of a 6 year old girl (Patient 1) who sustained a refracture after a trip and fall. She was treated with rebending of the radial implant and removal and replacement of the ulnar implant (c, d)
Mentions: The remaining five patients (83 %) had unacceptable alignment of their fractures and returned to the operating room for a second surgical procedure. One patient (Patient 6) had an attempt at closed reduction under conscious sedation in the emergency department due to concern for skin tenting, but had continued unacceptable alignment of the fracture. The remaining four patients were taken to the OR without an attempt at closed reduction in the emergency room due to surgeon preference. One patient (Patient 1, Fig. 1) had successful closed bending of the radial implant under general anesthesia in the OR with residual deformity of the ulnar implant and subsequent replacement of the ulnar implant. Two patients (Patients 3, 4) had removal of their intramedullary implants with replacement of new nails (Patient 3, Fig. 2). Patient 3 had an attempt at closed reduction in the OR prior to implant exchange with continued unacceptable alignment and underwent single bone fixation of the ulna with acceptance of the residual radial deformity because of the patient’s age. Patient 4 underwent replacement without an attempt at closed reduction. One patient (Patient 2, Fig. 3) had removal of nails with plate osteosynthesis because of his age and skeletal maturity utilizing stacked 1/3rd tubular plates for both the radius and ulna and one patient (Patient 6) with stacked 1/3rd tubular plates for the ulna and 3.5 mm LC-DCP plate for the radius (Synthes, West Chester, PA ). Patients 2 and 6 did not undergo an attempt at closed reduction prior to plating.Fig. 1

Bottom Line: The remaining five patients (83 %) returned to the operating room for treatment.All patients went on to uncomplicated radiographic union at a mean 3.6 months.This rare complication can be treated by several different methods, including revision TENS placement, revision to plate fixation, or in situ bending of rods, with the expectation for successful uncomplicated union.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.

ABSTRACT

Purpose: The purpose of this investigation is to present our institutional experience with fractures of the pediatric forearm with in situ intramedullary nails.

Methods: Six patients treated at our institution for forearm fracture with in situ intramedullary implants between 2004 and 2013 were reviewed. Patient demographics, injury and radiographic characteristics, method of treatment, time to union, and complications were collected from the medical record.

Results: 485 patients with forearm fractures were treated with intramedullary implants and six patients presented with a fracture with in situ implants (1.2 %). Fractures in all six patients resulted from a second traumatic event after radiographic healing but before implant removal at a mean of 13.0 months from the initial procedure. One patient had an adequately aligned fracture and was treated with casting without reduction. The remaining five patients (83 %) returned to the operating room for treatment. Two patients underwent rod removal and placement of new intramedullary implants, and two patients were treated with rod removal and plating without attempt at closed reduction. One patient underwent closed reduction in the operating room with successful re-bending of the radial implant and replacement of the ulna implant. All patients went on to uncomplicated radiographic union at a mean 3.6 months.

Conclusions: The incidence of fracture of pediatric forearm with in situ intramedullary implants is low. This rare complication can be treated by several different methods, including revision TENS placement, revision to plate fixation, or in situ bending of rods, with the expectation for successful uncomplicated union.

No MeSH data available.


Related in: MedlinePlus