The Compare Effects Of Elastic Intramedullary Nail And Plate Clinical In The Treatment Of Ulnar And Radial Shaft Fractures In Children

BackgroundUlnar and radial shaft fracture is a common type of fracture in the clinic,and adolescents,especially children,are the main susceptible population of such an injury.The occurrence of ulnar and radial shaft fractures is related to direct and indirect(torsion or conduction)violence,and the main manifestations after fracture are local pain,swelling,limb deformity,and forearm rotation disorder.If it is a complete fracture,friction sounds and bony crepitus can be heard.Children’s ulnar and radial fractures account for about25%-30%of the total number of fractures in children.Previous clinical treatments were mainly conservative treatments,that is,after manual reduction,plaster and braces are applied for external fixation.However,this kind of treatment is much effective in fractures without obvious dislocation and angular deformity,but it is not ideal for complex fractures.It cannot completely reduce the fracture.Instead,it may cause malformation,angular displacement and etc.,affecting the recovery of forearm function and the aesthetics of upper limbs.And thus,some children patients must be treated with surgery.For the internal fixation after surgical reduction,plates or screws are mostly used as a tool in the past.With the development of internal fixation materials,especially the application of elastic intramedullary nail,the effect of internal fixation is better with less invasiveness.With the continuous advancement of related technologies,the advantages of elastic intramedullary nail stand out.ObjectiveBy retrospectively comparing the curative effects of elastic intramedullary nailing and plate fixation in the treatment of children’s ulnar and radial shaft fractures,to comprehensively evaluate the safety,Compared with previous studies,this study is very innovative and can help identify the clinical application value of Titanium elastic nail and find out a safer and more effective surgical treatment for fractures of the ulnar and radial shaft in children.MethodsThis study selected 98 children patients with ulnar and radial shaft fractures who underwent operative treatment in our orthopedics department from January 2015 to March2018.According to the different surgical procedures,the 98 children patients were divided into two groups-the plate fixation group(control group)and the elastic intramedullary nailing group(experiment group).The differences of surgical outcomes,intraoperative related indicators,postoperative pain scores,postoperative healing time,postoperative forearm function,and postoperative complication incidence were compared between the two groups.ResultsOperation time:The operation time in the control group was(60.98±7.51)min while that in the experiment group was(51.40±7.01)min,between which the difference was statistically significant(t=34.023,p=0.00).Incision length:The length of surgical incision in the control group was(9.17±2.08)cm while that in the experiment group was(2.71±0.59)cm,between which the difference was also statistically significant(t=26.40,p=0.00).Bleeding volume:The bleeding volume in the control group was(52.40±0.95)ml while the bleeding volume in the experiment group was(6.36±0.20)ml,between which the comparison showed a statistically significant difference(t=60.61,p=0.00).Mean hospitalization stay:The mean hospitalization stay in the control group was(13.64±2.78)d while that in the experiment group was(7.95±1.01)d,between which the comparison also showed a statistically significant difference(t=18.17,p=0.00).Fracture union time:The fracture union time in the control group was(15.48±1.84)w while that in the experiment group was(11.10±1.17)w,and also a statistically significant difference can be observed when the two groups were compared in terms of the fracture union time(t=28.78,p=0.00).Postoperative forearm function evaluation:The Anderson et al.scoring system was adopted to evaluate the postoperative forearm function in the two groups on respective month 3 and 6 postoperation.The total excellent rate in the control group on month 3postoperation was 71.42%while the total excellent rate in the experiment group was83.92%,between which a statistically significant difference can be observed(χ~2=4.85,p=0.03).On month 6 postoperation,the excellent rates in the two groups were respectively88.10%and 92.86%,between which the comparison also showed no statistically significant difference(χ~2=0.91,p=0.34).Complication incidence:The incidences of complications such as incision infection,re-fracture,malunion,and irritation symptom showed no statistically significant difference when compared between the two groups(χ~2=0.716,p=0.397;χ~2=0.716,p=0.397;χ~2=1.347,p=0.246;χ~2=0.758,p=0.384).The incidence of fracture delayed union in the control group was significantly higher than that in the experiment group(χ~2=4.276,p=0.039).ConclusionCompared with plate fixation,the Titanium elastic nail in the treatment of children’s ulnar and radial shaft fracture presented the advantages of less bleeding,shorter operation time,shorter postoperative fracture union time,early postoperative forearm function recovery and less occurrence of complications,and is a safe and effective surgical method for such fractures,deserving to be promoted in clinical practice.