Title : Safety and efficacy of antegrade elastic stable intramedullary nail fixation for pediatric distal radius metaphyseal- Diaphyseal junction fractures
Abstract:
Background and Purpose: The distal radial metaphyseal-diaphysis junction (DRMDJ) is anatomically distinct, featuring muscle tendon migration areas, sparse muscle attachment, reduced vascular perforations, and a proximally expanding medullary cavity. Pediatric fractures in this region are challenging to treat, being too distal for Retrograde Elastic stable Intramedullary Nail (Re-ESIN) fixation and too proximal for conventional K-wire fixation. We introduce Antegrade Elastic Stable Intramedullary Nail Fixation (An-ESIN) as an innovative approach for pediatric DRDMJ fractures, particularly highlighting the "safe zone" for pin entrance to avoid the posterior interosseous nerve, aiming to assess its safety and efficacy compared to K-wire fixation and Re-ESIN.
Methods: From November 2017 to September 2022, 113 pediatric patients with unstable and displaced DRDMJ fractures were treated with An-ESIN fixation. The procedure entailed creating an entry site at the posterolateral aspect of the proximal radius, 2-4 cm distal to the articular surface, to engage the ESIN. We assessed patient demographics, complications, removal times, and intraoperative hardware removal times. Furthermore, we reviewed the literature from the past three years to study other surgeons' commonly used methods, including K-wire fixation and Re-ESIN, and compared surgical technique data, surgical complications, and treatment outcomes.
Results: The mean operation time for An-ESIN fixation was 51 ± 11 minutes, with intraoperative blood loss at 5.3 ± 3.7 ml. Postoperative alignment rates were 93.3% on the anteroposterior (AP) view and 95.2% on the lateral view. Residual angulation was 3.3 ± 1.2° on the AP view and 2.9 ± 0.8° on the lateral view. According to the Gartland-Werley scale, 95.5% of cases were rated as excellent or good. One case of delayed union was noted, and 12 patients experienced a temporary 30-degree loss of rotational motion, which resolved after nail removal. No infections or injuries to tendons, nerves, or growth plates were observed during the follow-up period. Comparatively, the An-ESIN method demonstrated fewer complications, shorter operation times, less blood loss, and superior alignment compared to K-wire fixation and Re-ESIN.
Conclusions: An-ESIN fixation is a minimally invasive, easy-to-learn, safe, and effective technique for treating pediatric DRDMJ fractures. It is recommended as the optimal choice for pediatric DRMDJ fractures due to its superior outcomes and safety profile.
