Clinical Study Of Open/closed Reduction Of Elastic Intramedullary Nail In The Treatment Of Ulnar And Radial Shaft Fractures In Children

Objective Shaft fracture of ulna and radius is the third most common fracture in children,second only to distal fracture of ulna and radius and supracondylar fracture of humerus.Elastic intramedullary nail fixation has become more common for ulnar and radial shaft fractures in children who need surgical treatment.In the process of treatment,some children were treated with open reduction at the broken end of the fracture.However,there are few studies on the comparison of the effects of closed reduction and open reduction of elastic intramedullary nail in the treatment of ulnar and radial shaft fractures in children.In this paper,we will explore the effect of open reduction and closed reduction on the prognosis of fracture,at the same time,explore the influence of the length of operation in the closed reduction group on the postoperative effect,and discuss the influencing factors of related complications.Methods 145 patients with ulnar and radial shaft fractures treated in the Department of Orthopaedics,Anhui Children’s Hospital from January 2017 to June 2019 were divided into two groups: open reduction group and closed reduction group.The postoperative healing and complications were analyzed and compared between the two groups.The postoperative functional recovery was evaluated according to Anderson score,and the appearance of forearm was evaluated according to VAS score.At the same time,whether the operation time of the children in the closed reduction group was more than 30 minutes was divided into the observation group(< 30min)and the control group(> 30min).The postoperative healing and complications were analyzed and compared between the observation group and the control group.The postoperative functional recovery was evaluated according to the Anderson score standard,and the appearance of the forearm was evaluated according to the VAS score.Results 145 children were followed up for 12 to 28 months.The excellent and good rate of postoperative Anderson function score was 99.3%.There was no significant difference in postoperative Anderson function score between closed reduction group and open reduction group(P > 0.05).In the closed reduction group,there was no significant difference in postoperative Anderson function score between the observation group and the control group.The VAS score of forearm appearance was not satisfactory in 6 cases,including 3 female patients and 3 male patients.There was a significant difference in the VAS score of forearm appearance between the closed reduction group and the open reduction group(P < 0.05).In the closed reduction group,there was no significant difference in the VAS score of the forearm appearance between the observation group and the control group(P > 0.05).Postoperative complications occurred in 9 cases of 145 children,limitation of thumb extension in 4 cases,recurrent fracture in 2 cases,nail tail irritation in 2 cases and postoperative incision infection in 1 case.there were no complications such as nerve injury,osteofascial compartment syndrome,fracture malunion,premature closure of epiphysis and so on.Comparing the incidence of complications between the closed reduction group and the open reduction group,the incidence of complications in the closed reduction group(5.5%)was lower than that in the open reduction group(7.6%),but the difference was not statistically significant(P >0.05).In the closed reduction group,the incidence of complications in the observation group(4.4%)was lower than that in the control group(6.7%),but the difference was not statistically significant(P > 0.05).Conclusion closed reduction with elastic intramedullary nail is a suitable method for the treatment of ulnar and radial shaft fractures in children with good functional recovery and few complications.The satisfaction rate of postoperative forearm appearance in the closed reduction group was higher than that in the open reduction group,and the difference was statistically significant.Prolonging the operation time of closed reduction did not affect the postoperative function and complications.Therefore,we can appropriately prolong the operation time of elastic intramedullary nail in the treatment of ulnar and radial shaft in children,and adopt a variety of methods and techniques to achieve closed reduction.