| ObjectivesThrough a retrospective case series study,the clinical effects and complications of elastic intramedullary nail internal fixation and different methods in the treatment of ulnar and radial fractures in children were compared,and the effects of related factors on clinical prognosis were analyzed.This study can provide reference for clinical treatment of ulnar and radial fractures.MethodsPart IA total of 96 children with ulnar and radial shaft fractures were admitted to the First Affiliated Hospital of Hainan Medical University from 2012 to 2022.By visiting the electronic medical record and following up with patients and/or their families,the general information,operation-related information,hospitalization information,and prognosis information were collected and analyzed.According to the mode of treatment,the patients were divided into three groups: elastic intramedullary nail group(n=51),plate and screw group(n=31)and cast group(n=14).By comparing the clinical data of the three groups,to evaluate the advantages of each treatment in the forearm shaft fracture.All patient data were processed and analyzed using SPSS27.0statistical software.Part ⅡA total of 52 children with metaphyseal distal forearm fractures were admitted to the First Affiliated Hospital of Hainan Medical University from 2012 to 2022.By visiting the electronic medical record and following up with patients and/or their families,the general information,operation-related information,hospitalization information,and prognosis information were collected and analyzed.According to the mode of treatment,the patients were divided into four groups: elastic intramedullary nail group(n=10),plate and screw group(n=14),Kirschner wire group(n=22)and cast group(n=6).By comparing the relevant clinical data of the four groups,to evaluate the advantages of each treatment in the metaphyseal distal forearm fractures.All patient data were processed and analyzed using SPSS27.0 statistical software.Part ⅢA total of 61 children who were treated by elastic intramedullary nail fixation in the First Affiliated Hospital of Hainan Medical College from 2012 to 2022 were admitted.By visiting the electronic medical record and following up with patients and/or their families,the clinical data of the children were collected and analyzed.The children were divided into different groups according to their general information:(1)gender: male(n=48),female(n=13);(2)age: <13 years(n=37),≥13years(n=13);(3)weight: <50kg(n=50),≥50kg(n=11);(4)BMI: <18.5(n=44),[18.5,24)(n=13),≥24(n=4);(5)reduction of fracture: closed reduction internal fixation(n=43),open reduction internal fixation(n=18);(6)the point of time of operation: A(08:00～15:30)(n=21),P(15:30～23:30)(n=28),N(23:30～08:00)(n=12);(7)waiting time from injury to operation: ≥48 hours(n=27),< 48 hours(n=34);(8)fracture pattern: 22-D/4.1(n=16),(22r-D/4.1～5.2)&(22u-D/4.1～5.2)(n=15),23-M/3.1(n=8),22-D/5.1(n=20),21r-M/3.1 & 23r-M/3.1(n=2).By analyzing and comparing the differences in the clinical effects of elastic intramedullary nail internal fixation(healing time of fracture,the site of maximum radial bow and the maximum radial bow after removal of fixation,palmar tilt and ulnar inclination of the affected side,rotation function of forearm,complications)under different factors,to explore the influence of non-operative factors on clinical prognosis.All patient data were processed and analyzed using SPSS27.0 statistical software.ResultsPart IGeneral data: in terms of age,the cast group was younger than the plate and screw group(P < 0.05).In terms of the waiting time from injury to operation,the cast group was shorter than the plate and screw group and the elastic intramedullary nail group(P < 0.01).There was no statistical difference in other general data among the three groups(P > 0.05).Hospitalization data: the length of hospitalization in the elastic intramedullary nail group was shorter than that in the plate and screw group(P < 0.001).The cost of initial hospitalization in the cast group was the least,followed by the elastic intramedullary nail group,that in the plate screw group was the most expensive(P<0.05),The cost of removal of internal fixation in the elastic intramedullary nail group was less than that in the plate and screw group(P < 0.001).Operation-related data: the operation time of reduction and fixation was the shortest in the cast group,the second in the elastic intramedullary nail group,and the longest in the plate and screw group(P < 0.001).The elastic intramedullary nail group was superior to the plate and screw group in the amount of blood loss during operation,the length of incision,the incision cicatrized time and the time from operation to internal fixation.There was no statistical difference in the healing time of fracture among the three groups.Surgical prognosis: in terms of the maximum radial bow(r/y),the elastic intramedullary nail group was closer to 7.21% than the plate and screw group(P <0.001).In terms of ulnar inclination,the plate and screw group was closer to 23 °(P <0.001).There was no statistical difference among the three groups in terms of x/y,palmar tilt,postoperative complications and Grace and Eversman scores.Part ⅡGeneral data: closed reduction of fracture was dominant in elastic intramedullary nail group,open reduction of fracture was dominant in Kirschner wire group(P <0.01).There was no statistical difference in BMI,Tscherne Classification,age,affected side,cause of injury,waiting time from injury to operation and gender among the four groups.Hospitalization data: in terms of the cost of initial hospitalization,cast group was the least,followed by Kirschner wire group,elastic intramedullary nail group and plate and screw group(P < 0.001).The cost of removal of internal fixation in Kirschner wire group was less than that in plate and screw group(P < 0.001).There was no statistical difference in the length of hospitalization among the four groups.Operation-related data: in terms of operation duration of reduction and fixation,cast group and elastic intramedullary nail group were shorter,plate and screw group and Kirschner wire group were longer(P < 0.05).The healing time of fracture in Kirschner wire group was shorter than that in elastic intramedullary nail group and plate and screw group(P < 0.01).In terms of blood loss during operation and the length of incision,elastic intramedullary nail group was the least,followed by Kirschner wire group and plate and screw group(P < 0.05).The incision cicatrized time in the elastic intramedullary nail group was shorter than that in the plate and screw group(P < 0.05).The time from operation to removal of internal fixation in the Kirschner wire group was shorter than that in the elastic intramedullary nail group and plate and screw group(P < 0.05).The operation time in the Kirschner wire group was shorter than that in the plate and screw group(P < 0.01).Surgical prognosis: In terms of maximum radial bow(r/y),the elastic intramedullary nail group was closer to 7.21%(P < 0.05).The ulnar inclination of the elastic intramedullary nail group was poorer than that of the other groups(P < 0.05).The palmar tilt of the Kirschner wire group was closer to 11 °(P < 0.05).There was no statistical difference among the four groups in x/y,incidence of complications and Grace and Eversman scores.Part ⅢIn terms of the postoperative maximum radial bow(r/y),the female was closer to7.21% than the male(P<0.05),and the closed reduction was better than the open reduction in the healing time of fracture and Grace and Eversman scores(P<0.05).However,different age,weight,BMI,operation time,waiting time from injury to operation and fracture pattern had no significant effect on the clinical effect of ESIN.ConclusionsPart IIn the treatment of forearm shaft fracture in children,elastic intramedullary nail has the advantages of simple,small incision,less blood loss,rapid fracture healing,greater ability to correct radial bow,short length of hospitalization,low total cost and so on.When considering the treatment of forearm shaft fractures in children who require surgery,priority should be given to this operation.Part ⅡElastic intramedullary nail has the advantages of short operation time,small incision,short incision cicatrized time,less blood loss and better correction of radial bow in the fixation of metaphyseal fracture of forearm in children.However,in terms of fracture healing,recovery of wrist anatomical angle and total cost,elastic nail fixation is inferior to Kirschner wire,and the total incidence of complications in elastic nail fixation is higher than that of each group.Plate and screw fixation has an advantage in restoring the anatomical angle of the wrist.The advantage of cast fixation lies in its easy operation and low cost.In this part of the study,elastic nail fixation does not show obvious advantages.When children have metaphyseal fractures of the forearm,it is necessary to take into account the specific conditions of the children(age,severity of the fracture,aesthetic requirements),family status(economic statusand,whether there is sufficient time for nursing),as well as medical institutions(whether the equipment is complete,proficiency in surgery)and so on.After comprehensive consideration,the appropriate individualized treatment scheme was selected.Part ⅢAccording to the prognosis of forearm fracture treated with elastic nail in children,girls were better than boys in correcting radial bow,closed reduction was better than open reduction in healing time of fracture and Grace and Eversman scores,but there was no significant effect on the clinical effect of elastic nail in age,weight,BMI,operation time,waiting time from injury to operation and fracture pattern.When the fracture is fixed with elastic intramedullary nail,it can be more inclined to female and closed reduction,but because this part of the study is a retrospective study and the sample size is small,it still needs to be considered in many aspects when choosing the treatment. |
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