| Objective A metaphyseal transition fracture is a special type of fracture of the distal ulna and radius.Careful physical examination and antero-lateral radiographs of the distal metaphysis are usually sufficient to diagnose a metaphyseal transition fracture.It can be divided into complete or incomplete fracture according to the degree of cortical involvement.Manual reduction and plaster external fixation are often the preferred nonsurgical treatment for incomplete or mildly displaced metaphyseal zone fractures of the distal ulna and radius because of the significant remodeling potential for forearm fractures in children.However,for fractures in the metaphysis zone of distal ulna and radius with complete severe displacement,surgical treatment is preferred clinically due to the unstable fracture,which is not easy to be reduced or the fracture is prone to be redisplaced after reduction.At present,the choice of surgical method and internal fixation for this fracture is still controversial.The objective of this study was to investigate the efficacy and prognosis of anterograde elastic intramedullary nail fixation in children with metaphyseal transitional zone fracture of distal ulna and radius.Methods A total of 73 eligible children with metaphyseal fracture of distal radius in our hospital from January 2017 to July 2022 were collected and analyzed.The children were divided into 2 groups according to different methods of radial internal fixation.Chi-square test and independent sample T-test were used to compare gender,side,age,injury mechanism,time from injury to surgery,operation time,intraoperative fluoroscopy times,and the proportion of patients who failed closed reduction and underwent open reduction(hereinafter referred to as incision rate)between the two groups of children in the intramedullary nail group(radius was fixed by anterograde elastic intramedullary nail)and the Kirschner wire group(radius was fixed by retrograde Kirschner wire).Postoperative plaster removal time,postoperative complications(nail tail irritation,fracture redisplacement,nerve tendon injury,delayed healing,non-healing),Anderson evaluation criteria were used to evaluate the postoperative forearm functional recovery,and the postoperative forearm aesthetic status was evaluated according to the VAS score.Results Both groups were followed up for 6 to 15 months [(10.6±2.3)months].There were no significant differences in gender,side,age,injury mechanism and time from injury to operation between the two groups(P > 0.05).The operative time of the intramedullary nail group was(63.9±30.1)min,and that of the Kirschner wire group was(57.9±34.1)min(P=0.425).The number of intraoperative fluoroscopy in the intramedullary nail group was(19.5±4.6),significantly less than that in the Kirschner wire group(24.0±9.7)(P=0.014).The incision rate of the two groups was2.7% in the intramedullary nail group,which was significantly lower than 11.11% in the Kirschner wire group.The time of plaster fixation in the intramedullary nail group(3.4±0.7)was less than that in the retrograde Kirschner wire group(6.2±0.8)(P < 0.05).No complications such as osteofascial compartment syndrome,epiphyseal premature closure,fracture malunion,delayed union or non-union were found in the two groups during postoperative follow-up.In the intramedullary nailing group,there were 2 cases of nail-tail bursae,and symptoms disappeared after nailing.The forearm movement of one case with deep branch of radial nerve injury recovered well after nailing nerve exploration.In the Kirschner wire group,there were 2 cases of postoperative malunion,3 cases of nail eye infection and 3 cases of Kirschner wire loosening(1 case caused malunion,3 cases found loosening during nail extraction).Complications in the anterograde intramedullary nail group were significantly less than those in the retrograde Kirschner wire group.At the last follow-up,it was found that the excellent and good rate of Anderson forearm function score was 83.78% in the intramedullary nail group and 86.11% in the Kirschler wire group.There was no statistical difference in Anderson forearm function score between the two groups(P>0.05).Postoperative visual VAS scores of forearm between the intramedullary nail group and the Kirschner wire group showed no statistical difference(P>0.05).Conclusion Compared with Kirschner wire internal fixation,anterograde intramedullary nail internal fixation for radius has fewer intraoperative fluoroscopy times,fewer postoperative complications,and earlier removal of plaster,which is conducive to early functional exercise.There is no significant difference in long-term forearm function recovery and forearm appearance satisfaction rate between the two groups.Therefore,Anterograde elastic intramedullary nail fixation is also an option for children with metaphyseal metastases of distal ulna and radius. |
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