Contrastive study of three different treatments of unstable distal ulna and radius fractures in older children / 中华实用儿科临床杂志

ABSTRACT

Objective:To compare the clinical effect of manual reduction and plaster fixation, closed reduction and percutaneous K-wire fixation, as well as open reduction plate and elastic intramedullary pin fixation in the treatment of unstable distal ulna and radius fractures in older children.Methods:The clinical data of 110 cases treated in Department of Orthopedics, Children′s Hospital of Nanjing Medical University from January 2014 to December 2017, for unstable fractures of the distal ulna and radius were retrospectively reviewed.There were 73 males, 37 females, aged from 10 to 14 years[(11.6±2.3) years old]. According to the different treatments, the 110 cases were divided into 3 groups which included manual reduction group (48 patients), closed reduction and percutaneous K-wire fixation group (35 patients, K-wire fixation group) and open reduction with plate and elastic stable intramedullary nail fixation group (27 patients, open reduction group). All cases were treated with plaster external fixation.After the fracture healing, the plaster was removed and then exercises were begun.The data of operative time, fracture healing time, displacement rate and wrist function after treatment were recorded in the three groups and compared statistically.Results:There was no significant difference in general data between 3 groups before operation (all P>0.05). For the manual reduction group, K-wire fixation group and open reduction group, the operation time was (20.2±8.4) min, (35.4±12.2) min and (68.5±20.4) min, respectively; the clinical fracture healing time was (42.1±3.8) d, (44.2±4.3)d and (48.4±5.3) d; the cost of treatment was (2 000.4±551.3) Yuan, (8 000.2±1 151.6) Yuan and (20 010.7±2 453.3) Yuan, respectively.There were significant differences in operation time and cost treatment among the 3 groups ( χ2=11.266, F=58.427, all P<0.05). The Berton score of excellent and good were 89.6% (43/48 cases), 91.4% (32/35 cases) and 92.6% (25/27 cases) 3 months later after surgery in the manual reduction group, K-wire fixation group and open reduction group.The mean follow-up was (11.2±3.7) months(range 6-18 months). In the manual reduction group, there were 6 cases with fracture displacement within 2 weeks after the manual reduction.There were 3 cases with symptoms of caudal irritation in K-wire fixation group, which happened in 1 case in the open reduction group.No complications such as nonunion and iatrogenic nerve injury were found during the follow-ups. Conclusion:There is no significant difference in the wrist function among the 3 methods for the treatment of distal radius and ulna fractures in older children.The manual reduction therapy has a high fracture displacement rate.The open reduction therapy causes maximal operative trauma and costs highly.The percutaneous K-wire method is minimally invasive and has shorter operative time and a lower fracture displacement rate.Therefore, percutaneous K-wire is the optimal treatment for distal ulna and radius fractures.