Deep and extensive pediatric burns: retrospective evaluation of scheme of patients at the Department of Children's Developmental Defects Surgery and Traumatology SUM.

<b> Introduction:</b> Burns are one of the most common injuries among children. Despite the scale of the problem, there is no generally accepted algorithm for dealing with burn wounds in children in Poland. </br></br> <b>Aim:</b> The aim of our study was to evaluate our treatment scheme as well as the long-term effects of burn treatment in our department. </br></br> <b>Material and methods:</b> We conducted a telephone survey with the parents of patients treated at our ward in 01.01.2016-01.01.2021 due to thermal burns. To assess the cosmetic effect of treatment, the modified Vancouver Scar Scale (mVSS) was used, as well as the evaluation of parents' satisfaction with the treatment of patients on a scale from 1 to 10. Criteria to be included were the thermal burn of the skin to at least a 2b degree and/or burns with not less than 8% of the Total Body Surface Area (TBSA), as well as answering all the questions included in the questionnaire. The inclusion criteria were met by 38 out of 97 hospitalized patients. </br></br> <b>Results:</b> 26.32% of patients achieved 0 points on the mVSS, 21.05% achieved 1 point, 15.79% achieved 2 points, 15.79% achieved 3 points, 2.63% patients received 4 points, 5.26% patients received 5 points, 5.26% patients received 7 points, 2.63% patients received 8 points, 2.63% patients received 9 points, 2.63% of patients received 10 points, none of the patients received 6 and 11 points higher. 3% of parents rated their satisfaction at 5 points, 3% of caretakers as 7 points, 8% as 8 points, 8% as 9 points, and 89% as 10 points. </br></br> <b>Discussion:</b> Our treatment algorithm brings good therapeutic effects and is also very well received by the patients' parents. In order to carry out a nationwide standardization of the treatment of childhood burn wounds, it would be necessary to conduct a similarly constructed study in a multicenter setting.

Pleural empyema in children - benefits of primary thoracoscopic treatment.

INTRODUCTION: Pleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. The American Thoracic Society divides them into three stages: exudative, fibrinopurulent and organizing. The therapy depends on the stage. AIM: To assess whether thoracoscopy should be considered better than conservative treatment and to assess the feasibility of the thoracoscopic approach to the 3rd phase of pleural empyema. MATERIAL AND METHODS: The clinical course of 115 patients treated from 1996 to 2017 was analyzed. 45 patients operated on thoracoscopically after the failure of conventional treatment were compared with 70 patients treated by primary thoracoscopic drainage and decortication. RESULTS: The results of the study demonstrated that patients treated primarily by thoracoscopy had a shortened length of hospital stay (16.6 vs. 19.3 days), reduced drainage time (7.9 vs. 9.8 days), and shorter time of general therapy (31.8 vs. 38.0 days). They required fibrinolysis less frequently (12.8 vs. 26.7% of patients) and had reduced risk of reoperation (10 vs. 15.6% of cases). Operation time in the 3rd stage was only 15 min longer. The difference in length of hospital stay was only 0.8 days in favor of less severe cases. CONCLUSIONS: The thoracoscopic approach is safely feasible in the 3rd stage of pleural empyema and should be considered as the preferred approach. Furthermore, the post-operative stay and general course of the disease are milder whenever surgery would not be delayed by prolonged conservative treatment attempts.

The role of laparoscopy in paediatric and adolescent gynaecology.

Paediatric and adolescent gynaecology is a narrow field of medicine dealing with the diagnosis of and treatment of gynaecological diseases from the neonatal period to sexual maturity. The current trend in surgical gynaecology in the paediatric population is to minimise the degree of invasiveness of diagnostic and therapeutic procedures. This contributes to reducing the number of complications and the risk of infertility. Laparoscopic procedures are a challenge for paediatric surgeons and gynaecologists, not only because of the age of treated patients, and anatomical and physiological differences between different age groups but also because of the complexity of the pathology, the differentiation of cancer tumours, and the presence of congenital developmental defects.

Introducing enhanced recovery after surgery protocol in pediatric surgery.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a holistic perioperative care protocol created to improve treatment outcomes. Implementation of new rules radically changed the perioperative care of adult patients. The protocol refers to the preoperative, intraoperative and postoperative periods. OBJECTIVES: To describe a novel pediatric ERAS protocol designed for reverse stoma surgery and to compare a group of patients with implemented ERAS protocol to a group of patients from pre-ERAS period. MATERIAL AND METHODS: A retrospective comparative review was performed which included 14 patients from pre-ERAS period (2016-2017) and 13 patients in the ERAS period (2018-2019). Total parenteral nutrition (TPN) time, time to oral fluid intake, time to regular diet, time to stooling, and length of stay (LOS) were analyzed. RESULTS: In the ERAS period, the LOS decreased from 8.64 to 6.08 days, time to oral fluid intake decreased from 4.36 to 1 postoperative day, time to regular diet decreased from 6.14 to 3.23 postoperative day. Total parenteral nutrition decreased from 5.14 in the pre-ERAS period to 1.69 days in the ERAS period. With the progress of implementation of ERAS protocol, TPN was gradually withdrawn. CONCLUSIONS: The implementation of the pediatric ERAS in children undergoing reverse stoma surgery is safe, reduces patient's metabolic stress and improves treatment outcomes. However, further research is needed.

Evaluation of the usefulness of laparoscopy in the diagnosis and treatment of adnexal pathologies in the pediatric population.

INTRODUCTION: The current trend in adnexal surgery in children is to minimize the invasiveness of diagnostic and therapeutic procedures, reduce the number of complications and reduce the risk of infertility. AIM: Evaluation of the usefulness and effectiveness of laparoscopy in diagnostics and treatment of pathological lesions of adnexa in the pediatric population and evaluation of the correlation of imaging with the intraoperative diagnosis during laparoscopy. MATERIAL AND METHODS: The study included 89 patients aged 0-18 years (mean: 12.62) who underwent an emergency or elective laparoscopic procedure due to the suspicion of adnexa pathology in the imaging tests or in which intraoperative pathology of the adnexa was found without previous suspicion of these changes in the imaging tests. Patients were divided into 2 groups according to the procedure (emergency or elective) and into 4 age groups. RESULTS: The most frequent postoperative diagnosis was an adnexal cyst and ovarian tumor. The ratio of malignant to benign lesions was 0.087. In 32.58% of patients appendix pathology was found. Coexistence of adnexa and appendix pathology was statistically significantly more frequent in patients undergoing emergency surgery (p = 0.013). There was no correlation between the size of the tumor or ovarian cyst and the occurrence of adnexal torsion, and no correlation between the size of the tumor and the degree of torsion of the adnexa. Three conversions were performed. The average operation time was 63.7 min. CONCLUSIONS: Laparoscopic diagnosis and treatment of adnexal pathology seems to be safe due to the low percentage of perioperative complications. It shows high sensitivity in recognizing adnexal pathologies and other defects.

Adenomiomatosis vesicular en un adolescente, una afección muy rara / Adenomyomatosis of the gallbladder in an adolescent, a very rare condition

La adenomiomatosis vesicular es una enfermedad degenerativa adquirida que se caracteriza por proliferación epitelial con hipertrofia de la capa muscular y formación de trayectos fistulosos, conocidos como senos de Rokitansky-Aschoff. La adenomiomatosis se diagnostica principalmente mediante ecografía. No se conocen cabalmente la patogenia, la patología ni las indicaciones para cirugía de esta afección. Es sumamente rara en niños. En este artículo, presentamos el caso de un varón de 17 años con adenomiomatosis vesicular tratado adecuadamente con una colecistectomía laparoscópica

Adenomyomatosis of the gallbladder is an acquired, degenerative disease characterized by epithelial proliferation with hypertrophy of the muscularis layer with forming of sinus tracts, termed Rokitansky-Aschoff sinuses. Adenomyomatosis is diagnosed mainly by ultrasonography. The pathogenesis, pathology, and indications for surgery in this condition are not well understood. It is an extremely rare condition in children. We present a case of a 17-year boy with adenomyomatosis of the gallbladder successfully managed with laparoscopic cholecystectomy,

Adenomyomatosis of the gallbladder in an adolescent, a very rare condition. / Adenomiomatosis vesicular en un adolescente, una afección muy rara.

Adenomyomatosis of the gallbladder is an acquired, degenerative disease characterized by epithelial proliferation with hypertrophy of the muscularis layer with forming of sinus tracts, termed Rokitansky-Aschoff sinuses. Adenomyomatosis is diagnosed mainly by ultrasonography. The pathogenesis, pathology, and indications for surgery in this condition are not well understood. It is an extremely rare condition in children. We present a case of a 17-year boy with adenomyomatosis of the gallbladder successfully managed with laparoscopic cholecystectomy.

La adenomiomatosis vesicular es una enfermedad degenerativa adquirida que se caracteriza por proliferación epitelial con hipertrofia de la capa muscular y formación de trayectos fistulosos, conocidos como senos de Rokitansky-Aschoff. La adenomiomatosis se diagnostica principalmente mediante ecografía. No se conocen cabalmente la patogenia, la patología ni las indicaciones para cirugía de esta afección. Es sumamente rara en niños. En este artículo, presentamos el caso de un varón de 17 años con adenomiomatosis vesicular tratado adecuadamente con una colecistectomía laparoscópica.

Evaluation of liver-type fatty acid binding protein (L-FABP) and interleukin 6 in children with renal cysts.

BACKGROUND: Renal cysts, according to their etiology, can be divided into genetic and acquired cysts. This is of great importance in patients with cystic kidney disease with a possible poor prognosis to identify markers of early kidney damage. OBJECTIVES: The objective of this study was to evaluate the concentration of serum and urine liver-type fatty acid binding protein (L-FABP) and interleukin 6 (IL-6) in children with kidney cysts. MATERIAL AND METHODS: The study was conducted on a group of 39 children with kidney cysts including 20 subjects with autosomal dominant polycystic kidney disease (ADPKD). RESULTS: Serum and urine L-FABP concentration in children with renal cysts was significantly higher compared to the controls, regardless of the underlying type of cystic degeneration, number of cysts and gender. Also, serum and urinary IL-6 concentration was significantly higher than in the control group. There was a significant negative correlation between serum L-FABP concentration and standard deviation score (SDS) for diastolic blood pressure (DBP). A significant negative correlation was found between serum IL-6 concentration and systolic blood pressure (SBP), DBP and mean arterial pressure (MAP) values as well as SDS for SBP and DBP. In addition, a significant positive correlation was found between urinary IL-6 concentration and estimated glomerular filtration rate (eGFR). CONCLUSIONS: Higher concentration of L-FABP in serum and urine in children with kidney cysts indicates the early damage to the renal parenchyma, detectable before the onset of hypertension and other organ damage. Significantly higher serum and urinary IL-6 levels in children with cystic kidney disease compared to healthy children may suggest the role of this cytokine in chronic kidney disease development.

How often does urinary incontinence really affect primary school children?

OBJECTIVE: Introduction: Urinary incontinence should be treated as a pathology in patients who are at least 5 years old, a few percent of patients continue to suffer from this disorderin adolescence. It can be qualified as day-time incontinence (DUI) and nocturnal-incontinence (enuresis-NE). The aim: To assess the incidence of micturition disorders in children aged 7 to 10, to analyze accompanying symptoms and compare the results with previous studies. PATIENTS AND METHODS: Material and methods: Parents of 954 children (491 girls and 463 boys) were surveyed during parent-teacher meetings held in 2017 in 11 randomly selected schools in southern Poland. The questionnaire was based on International Children's Continence Society guidelines. Study population was divided into subgroups according to demographical data, presence of accompanying symptoms and the type of micturition disorder. RESULTS: Results: Minor wetting was common in the studied population, however the group of children with clinically significant incontinence becomes smaller after applying current ICCS criteria. ≥1 symptom of urinary bladder malfunction was reported in 18% of cases (17.5% girls and 18.8% boys). Significant (≥1/month) NE was present in 1,7 % of children and significant (≥1/month) DUI in 2,2%. Significant NE combined with significant DUI occurred in 1% of children. Relationships between incontinence and the age at which children stopped wearing diapers, urinary tract infections, soiling and constipation episodes were observed. CONCLUSION: Conclusions: Unified and clearly defined terminology should be used in order to correctly describe and compare the scale of this problem. Urinary incontinence should not be underestimated, because if untreated it may lead to physical, psychological and social disorders.

Pediatric achalasia. Single-center study of interventional treatment.

INTRODUCTION: Esophageal achalasia is a rare entity in children. However, young age is a factor of failure of conservative treatment, emphasizing the role of surgery. In our institution laparoscopic Heller's cardiomyotomy is the chosen procedure for surgical treatment. AIM: To assess the outcome of surgery for achalasia treatment in children operated on in a single institution. MATERIAL AND METHODS: A retrospective analysis of consecutive patient records from the years 1997 to 2014 was performed. There were 11 patients. Their mean age was 13 years, ranging from 6 to 17. Duration of symptoms was 2 to 36 months, mean 16. All 11 patients were operated on with a laparoscopic approach. Pneumatic dilatation was used both pre- and postoperatively but in no case was sufficient on its own. Collected data included patient demographics, preoperative symptoms and their duration, diagnostic findings and therapeutic means. Surgical procedures, complications and long-term follow-up were analyzed. The follow-up lasted from 1 to 10 years and finished when the patient reached 18 years of age. RESULTS: Twelve laparoscopic cardiomyotomies were performed with concomitant fundoplications, 10 Toupet and 2 Dor and one redo procedure. There were no deaths. Two perforations were repaired promptly. The success rate was 82%, though with subsequent dilatations. One failure was due to serious progression of the disease. CONCLUSIONS: In our opinion, laparoscopic Heller's myotomy is the procedure of choice for treating achalasia in children. Endoscopic balloon dilatation may be used as a complementary treatment, especially as a primary redo procedure.

Thoracoscopic resection of a bronchogenic cyst in a 17-year-old girl.

Bronchogenic cysts comprise approximately 6% of mediastinal tumors in children. The treatment consists in surgical resection of the cyst. The authors present the case of a 17-year-old girl who was accidentally diagnosed with a mediastinal cyst. The patient was successfully treated with thoracoscopic surgery with good early and late clinical outcomes.

Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents.

INTRODUCTION: Ovaries are one of the most common locations of tumor masses in children. Some of them require surgery due to the risk of malignancy or necrosis. This organ seems to be ideal for the laparoscopic approach. AIM: To evaluate the usefulness of laparoscopy in surgery of lesions located in the ovaries in patients under 18 years of age and assess the risk of changes in the ovaries in girls with acute abdominal symptoms. MATERIAL AND METHODS: Retrospective evaluation of hospital records of the period 1996-2012 from a single hospital was performed. 105 laparoscopic procedures of ovarian pathology in patients aged 0-18 (mean: 13.5) years were reviewed. The overall sample was divided into groups depending on the indication and mode of surgery. Group I: elective or emergency surgery, imaging findings of ovarian cysts bigger than 5 cm or causing pain. Group II: elective surgery, the ovarian tumor visible in imaging (solid mass or mixed). Group III: treatment for acute abdomen, without visible ovarian pathology in the preoperative imaging studies. Group IV: elective treatment of other indications, incidental finding. RESULTS: There were no deaths or major complications. There were no conversions. Average length of hospital stay after surgery was 2.5 days. The risk of appendicitis in patients referred for surgery due to ovarian cysts visualized in ultrasound, in the factual absence of ovarian pathology (false positive ultrasound), in the presented material was 5.2%. The risk of lesions in the ovaries in patients operated on due to acute abdominal pain, with no findings in the pre-operative ultrasound (false negative ultrasound), in the presented material was 7.4%. The risk of coexistence of changes in the ovaries with appendicitis found during the procedure due to acute abdominal pain in the study group was 6%. CONCLUSIONS: The laparoscopic treatment for ovarian masses is safe and efficient. The risk of wrong preoperative diagnosis (ovary mass vs. appendicitis) is in any direction between 5 and 8%, which is a number large enough to be taken into consideration when surgical training and legislation is concerned.

Epidural and opioid analgesia following the Nuss procedure.

BACKGROUND: Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. material/methods: The study subjects were 61 adolescents aged 11-18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents' consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted "butterfly" cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. RESULTS: Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. CONCLUSIONS: Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.

[Congenital sternal cleft: a case report]. / Wrodzony rozszczep mostka ­ opis przypadku.

Sternal cleft is a very rare congenital defect of sternum, reported only in limited number of publications. Surgical treatment in neonatal period is preferred. The case of child with congenital sternal cleft operated in 17 month of life with successful outcome of repair was reported.

Foreign body aspiration in children: diagnostic and therapeutic role of bronchoscopy.

PURPOSE: Assessment of bronchoscopy usefulness for diagnosis and treatment in children suspected of foreign body aspiration. MATERIAL AND METHOD: There were 27 boys and 18 girls in the age from 15 month to 14 years (average 5.5 years). Rigid bronchoscopy was performed under general anaesthesia. Assessment of the respiratory tract was done and in cases with foreign body bronchoscopic evacuation was executed. Medical records and video recordings of bronchoscopy procedures were subjected to retrospective analysis. RESULTS: In 28 children (62.2%) during bronchoscopy, foreign body aspiration recognized in 17 (37.8%) bronchoscopy cases was negative. In 27 patients, foreign bodies were removed. In one child, foreign body was evacuated during second bronchoscopy after preparing proper instrumentation. There were no complications in post-bronchoscopic period. Operating time was from 5 to 90 min, average time was noted to be 24 min. Average time of hospital stay was 2-3 days. CONCLUSIONS: Aspiration of foreign body should be suspected in all cases of bronchopulmonary infection with atypical course. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body. In children rigid bronchoscopy is still the method of choice.

Laparoscopic splenectomy in children--a multicenter experience.

PURPOSE: Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a multicenter experience of 159 laparoscopic splenectomies. METHODS: Records of 159 children, who underwent LS in 3 pediatric surgery centers between 1996 and 2006, were reviewed retrospectively with a special questionnaire. The indication for splenectomy were hematologic disorders (147), esophageal varices (6), splenic cyst (5), and tumor of the tail of the pancreas (1). The LS was performed using standard laparoscopic technique and instrumentation. RESULTS: There were 75 boys and 84 girls. Median age was 12.5 years (range, 2-19.4 years). Laparoscopic splenectomy alone was performed in 118 cases and LS with cholecystectomy or cholecystotomy in 36. In 5 cases, LS was performed together with fundoplication. Eight LS required conversion to an open procedure for following reasons: severe bleeding (3), massive splenomegaly (1), anatomical (2), and technical aspects (2). Accessory spleens were identified in 20 cases (12.6%). There was no mortality. Complications consisted of 8 conversions and postoperatively of mild generalized infection in 3 children and abdominal bleeding that resulted in re-laparoscopy in 1 case. CONCLUSIONS: Laparoscopic splenectomy can be safely and effectively performed in children.

Chemical, corrosion and topographical analysis of stainless steel implants after different implantation periods.

The aim of this work is to examine the corrosion properties, chemical composition, and material-implant interaction after different periods of implantation of plates used to correct funnel chest. The implants are made of 316L stainless steel. Examinations are carried out on three implants: new (nonimplanted) and two implanted for 29 and 35 months. The corrosion study reveals that in the potential range that could occur in the physiological condition the new bar has the lowest current density and the highest corrosion potential. This indicates that the new plate has the highest corrosion resistance and the corrosion resistance could be reduced during implantation by the instruments used during the operation. XPS analysis reveals changes in the surface chemistry. The longer the implantation time the more carbon and oxygen are observed and only trace of elements such as Cr, Mo are detected indicating that surface is covered by an organic layer. On some parts of the implants whitish tissue is observed: the thickness of which increased with the time of implantation. This tissue was identified as an organic layer; mainly attached to the surface on the areas close to where the implant was bent to attain anatomical fit and thus where the implant has higher surface roughness. The study indicates that the chest plates are impaired by the implantation procedure and contact with biological environment. The organic layer on the surface shows that the implant did not stay passive but some reactions at the tissue-implant interface occurred. These reactions should be seen as positive, as it indicates that the implants were accepted by the tissues. Nevertheless, if the implants react, they may continue to release chromium, nickel, and other harmful ions long term as indicated by lower corrosion resistance of the implants following implantation.

Laparoscopic appendectomy for simple and complicated appendicitis in children--safe or risky procedure.

OBJECTIVES: The aim of the study was to present our experience and to assess the advantages of laparoscopic appendectomy, particularly in children with perforated appendicitis. MATERIALS AND METHODS: Between 1999 and 2005, 505 laparoscopic appendectomies were performed. In children aged between 2 and 18 years, number, sex, age, histologic type of appendicitis, additional surgical procedures, number and type of complications, time of procedure, and hospitalization were analyzed. RESULTS: There was no need for conversion even in perforated appendicitis and in technically difficult cases. In 21 (4.16%) children in postoperative period minor complications occurred. Average operating time was 43 minutes. Average hospital stay was 2.4 days. CONCLUSIONS: Laparoscopic appendectomy is good alternative for classic appendectomy, irrespective of the degree of inflammation. Accurate cleaning and rinsing of the abdominal cavity essentially decreases the quantity of complications even in cases with perforated appendicitis. This suggests the expansion of indications toward laparoscopic appendectomy in case of all children with acute appendicitis.

Difficulties and limitations in minimally invasive repair of pectus excavatum--6 years experiences with Nuss technique.

OBJECTIVE: In 1998, Dr Donald Nuss proposed minimally invasive repair of pectus excavatum (MIRPE) which did not require the osteochondrous parts of the anterior chest wall to be resected. The paper aims at presenting the authors' own 6 years of experience in funnel chest repair with MIRPE technique. Also, many technical problems of this method are discussed. MATERIALS AND METHODS: Between 1999 and 2005, 461 patients (99 female and 362 male, aged 3-31 years, mean age 15.2 years) with pectus excavatum were operated with the Nuss technique. All patients were operated-on according to the original operative protocol proposed by Donald Nuss. With growing experience, own modifications were introduced. Insertion of two bars was done in 17.4%, transverse sternotomy in adolescents with rigid anterior chest wall in 7.8%, limited excision of the rib cartilages in 5.9%, and parasternal fixation of the bar to prevent it from rotating in 59.7% of patients. RESULTS: There were no deaths. Intraoperative complications were noted in 19 (4.1%) patients and postoperative ones were observed in 43 (9.3%) patients. The operative time ranged from 25 to 130 min (52 min on average). In 192 (41.6%) patients, an epidural block was used. The hospital stay ranged from 4 to 12 days with the mean of 5.3 days. A redo procedure for the bar rotation was necessary in 13 (2.8%) patients. The support bar has been removed in 260 (56.4%) patients so far. In all the patients, an adequate contour of the anterior chest wall has been maintained. CONCLUSIONS: MIRPE proposed by Nuss has all the features of a minimally invasive procedure and is straightforward. Better clinical results are achievable in patients under 12 years of age with a symmetric deformity. In older patients (over 15 years of age) with a rigid chest or with an asymmetric deformity, additional procedures are required to achieve a comprehensive correction of the deformity. Recent results and forward clinical observations may give proof to establish MIRPE as a method of choice in funnel chest correction.

Stabilization of forearm fractures in children using intramedullary Kirschner wires.

Background. Minimally invasive intramedullary stabilization is a widely accepted method for treating long bone fractures in children. Indications concerning age and type of fracture have increased in the last decade. The aim of our study was to assess outcome in intramedullary Kirschner wire stabilization used to treat forearm fractures in children. Material and methods. From 1997 to 2004 intramedullary stabilisation was performed in 118 patients, 27 girls and 91 boys, ranging in age from 1 to 17 years (average 10.7 years). There were 191 fractured bones, 116 radius and 75 ulna. The procedure was done under general anesthesia. After manual reposition, the fracture was stabilized with an intramedullary Kirschner wire introduced under X-ray control. Results. There were no intraoperative complications. The mean duration of hospitalization in cases with isolated forearm fracture was 1.6 days. In 5 cases (4.2%) a minor soft tissue infection at the point of wire introduction was observed. There were no bone infections or damage to growth cartilage. In 112 operated children (94.9%), a good clinical outcome was achieved, while in 6 cases (5.1%) the outcome was satisfactory. Conclusions. Intramedullary Kirschner wire stabilization is a technically easy minimally invasive procedure. The method gives good clinical outcomes and decreases hospitalization, treatment costs, and stress connected with hospitalization. Intramedullary stabilization should be method of choice in the surgical treatment of forearm fractures in children.