Functional Outcome of Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures in Children

Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures

Authors

  • Imran Khan Saidu group of Teaching Hospitals, Swat, Pakistan
  • Alamzeb Khan Department of Orthopedics, Khalifa Gul Nawaz Hospital, Bannu, Pakistan
  • Mudir Khan Department of Orthopedics, Lady Reading Hospital, Peshawar, Pakistan
  • Muhammad Rasool Department of Orthopedics, Jalil International Hospital, Swat, Pakistan
  • Abdul Hamid Saidu group of Teaching Hospitals, Swat, Pakistan
  • Saeed Ullah Saidu group of Teaching Hospitals, Swat, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i04.402

Keywords:

Forearm Fracture, Kirchner Wires, Pediatric Forearm Fractures, Open Reduction

Abstract

Pediatric patients with unstable radius-ulna fracture can be treated with intramedullary Kirschner wire fixation. Objective: To determine the functional outcome of Intramedullary Kirschner Wire fixation in unstable radius-ulna fractures in children. Methods: All pediatric age patients were enrolled into the study with unstable radius and ulna fracture. Informed consent was taken before study. Proper history, examination and X-rays of the forearm was taken after taking consent from the guardian of the patient. Under general anesthesia and tourniquet, control radius was first fixed through a small volar incision by drilling a k wire at fracture site in radius so that the wire exits on the dorsolateral side of the radius. The fracture was than reduced and the wire tapped with hammer to the radial head. Similarly, ulna was fixed by first drilling the wire up to the olecranon process and after reduction of the fracture down to the styloid process. After checking stability both bones, both wounds were washed with normal saline and closed in reverse order and above elbow cast was applied for three to four weeks. Results: In this study, as per functional outcomes, 5(4.0%) patients had good outcome, 80(64%) patients had excellent outcomes whereas 40(32%) patients had poor outcomes. Conclusions: This study demonstrates excellent functional outcome of Intramedullary Kirschner Wire fixation in unstable both bone forearm fractures in children.

References

Rehmani R. Childhood injuries seen at an emergency department. Journal of Pakistan Medical Association. 2008 Mar; 58(3): 114.

Naranje SM, Erali RA, Warner WC, Sawyer JR, Kelly DM. Epidemiology of pediatric fractures presenting to emergency departments in the United States. Journal of Pediatric Orthopaedics. 2016 Jun; 36(4): e45-8. doi: 10.1097/BPO.0000000000000595.

Hassan FO. Hand dominance and gender in forearm fractures in children. Strategies in Trauma and Limb Reconstruction. 2008 Dec; 3: 101-3. doi: 10.1007/s11751-008-0048-6.

Chung KC and Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. The Journal of Hand Surgery. 2001 Sep; 26(5): 908-15. doi: 10.1053/jhsu.2001.26322.

Ryan LM, Teach SJ, Searcy K, Singer SA, Wood R, Wright JL, et al. Epidemiology of pediatric forearm fractures in Washington, DC. Journal of Trauma and Acute Care Surgery. 2010 Oct; 69(4): S200-5. doi: 10.1097/TA.0b013e3181f1e837.

Bowman EN, Mehlman CT, Lindsell CJ, Tamai J. Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure. Journal of Pediatric Orthopaedics. 2011 Jan; 31(1): 23-32. doi: 10.1097/BPO.0b013e318203205b.

Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. Journal of Pediatric Orthopaedics. 2008 Jun; 28(4): 403-9. doi: 10.1097/BPO.0b013e31816d71f2.

Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent intramedullary nail. Journal of International Medical Research. 2016 Feb; 44(1): 122-30. doi: 10.1177/0300060514566650.

Baldwin K, Morrison MJ, Tomlinson LA, Ramirez R, Flynn JM. Both bone forearm fractures in children and adolescents, which fixation strategy is superior—plates or nails? A systematic review and meta-analysis of observational studies. Journal of Orthopaedic Trauma. 2014 Jan; 28(1): e8-14. doi: 10.1097/BOT.0b013e31829203ea.

Vopat ML, Kane PM, Christino MA, Truntzer J, McClure P, Katarincic J, et al. Treatment of diaphyseal forearm fractures in children. Orthopedic Reviews. 2014 Apr; 6(2): 94-9. doi: 10.4081/or.2014.5325.

Pace JL. Pediatric and adolescent forearm fractures: current controversies and treatment recommendations. Journal of the American Academy of Orthopaedic Surgeons. 2016 Nov; 24(11): 780-8. doi: 10.5435/JAAOS-D-15-00151.

Carson S, Woolridge DP, Colletti J, Kilgore K. Pediatric upper extremity injuries. Pediatric Clinics. 2006 Feb; 53(1): 41-67. doi: 10.1016/j.pcl.2005.10.003.

Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. Journal of Pediatric Orthopaedics. 1999 May; 19(3): 329-37. doi: 10.1097/01241398-199905000-00009.

National Guideline Clearinghouse. American Academy of Orthopedic Surgeons clinical practice guideline on the treatment of distal radius fractures. 2009. [Last cited: 9th May 2016]. Available at: http://www.guideline.gov/content.aspx?id=15486&search=distal+and+radius+and+ulna.

Şahin N, Akalın Y, Türker O, Özkaya G. ESIN and K-wire fixation have similar results in pediatric both-bone diaphyseal forearm fractures. Turkish Journal of Trauma and Emergency Surgery. 2017 Sep; 23(5): 415-20. doi: 10.5505/tjtes.2017.85891.

Vishwnath C, Satheesh GS. Surgical outcome of fracture both bones forearm in children using tens. National Journal of Clinical Orthopaedics. 2017 May; 1(2): 16-23.

Van der Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. Journal of Pediatric Orthopaedics. 1998 Jan; 18(1): 9-13. doi: 10.1097/01241398-199801000-00003.

Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. The Journal of Bone & Joint Surgery. 1989 Feb; 71(2): 159-69. doi: 10.2106/00004623-198971020-00001.

Cullen MC, Roy DR, Giza E, Crawford AH. Complications of intramedullary fixation of pediatric forearm fractures. Journal of Pediatric Orthopaedics. 1998 Jan; 18(1): 14-21. doi: 10.1097/01241398-199801000-00004.

Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. The Journal of Bone & Joint Surgery. 1992 Aug; 74(7): 1068-78. doi: 10.2106/00004623-199274070-00014.

Downloads

Published

2023-04-30
CITATION
DOI: 10.54393/pjhs.v4i04.402
Published: 2023-04-30

How to Cite

Khan, I. ., Khan, A. ., Khan, M. ., Rasool, M. ., Hamid, A. ., & Ullah, S. . (2023). Functional Outcome of Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures in Children: Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures. Pakistan Journal of Health Sciences, 4(04), 176–180. https://doi.org/10.54393/pjhs.v4i04.402

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)