ABSTRACT
Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children.Methods From January 2011 to December 2015,54 older children(31 males and 23 females) aged 8-14 years(average 11.4 years old) of humeral shaft fractures were treated in Children's Hospital of Nanjing Medical University with elastic stable intramedullary nail.The left side involved 24 cases and right involved 30 cases.Patients were divided into 3 groups according to different approaches:bilateral retrograde group (31 cases),radial retrograde group (15 cases) and anterograde group (8 cases).Abduction brace was carried out postoperatively for about 6 weeks.Implant removal took place about 3-4 months later,when the X-ray showed fracture line disappeared and continuous trabecular bone was formed.A retrospective study was performed to compare the operation time,imaging findings after the surgery,fracture healing time and recent complications among the 3 groups.Results Bilateral retrograde nailing operation lasted for an average of (51 ±25) min and residual angle in X-ray films postoperative was (5.4 ± 1.8) °.The radial retrograde nailing average operating time was(46 ± 12)min and average residual angle in X-ray films postoperative was (12.8 ±2.9)°,while anterograde nailing was (44 ±16) min and (13.0 ± 3.6)°.The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group,and the difference was statistically significant (F =19.340,P ＜ 0.01).Children were followed up for 6 to 18 months (averaged 11 months).Each fracture was healed successfully.The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8％ (30/31 cases),93.3％ (14/15 cases),87.5％ (7/8 cases).The excellent rates of Mayo scores of elbow joints 6 months after surgery were 93.5％ (29/31 cases),100.0％ (15/15 cases),100.0％ (8/8 cases).All fractures were healed without abnormal appearance or decreased range of motion.In terms of their complications,in the bilateral retrograde group,there was 1 case of iatrogenic ulnar nerve palsy and 5 cases with skin irritation.One case of skin irritation occurred in the radial retrograde group.Conclusions In treatment of humeral shaft fractures in older children,functional outcomes are similar in 3 groups.The technique of bilateral retrograde insertion is effective and has extensive applicability.
ABSTRACT
Objective To analyze the complications during and after the surgical treatment for long bone fractures in children with titanic elastic intramedullary nail(TEN),in order to improve the technique and potential shortcomings in these surgeries,and reduce the incidence of complications.Methods A retrospective study was done on the 182 children with long bone fractures treated with TEN from Jan.2005 to Jan.2008.A summary and analysis was made on the complications of these cases.Results All the 182 cases had the bones healed.During the operation,split in bone cortex was found in 3 cases,penetration into epiphysis by nails was found in 1 case.After operations,irritated skin and exposed nail was found in 3 cases,prolonged bone healing in 2 cases,limitation of range of motion in the knee in 1 case,bent nail in 1 case,difficulty in retracting the nail in 10 cases,shortening in 2 cases,second fracture of the healed long bone in 1 case.The results were excellent in 173 cases,good in 6 and fair in 3,and the rate of excellent and good was 98 %.Conclusions Though it has certain complications,the technique of TEN in the treatment of children's long bone fractures has more advantages over other internal fixations.Carefully performing the procedure according to the principal of TEN can decease and prevent most of these complications.