| Abstract | Objective: The aim of the study was to establish the demographic and clinical characteristics of children operated by the ESIN method for radial head and neck fractures, analyze the outcomes of treatment and the rate of complications, and compare them with other relevant studies.
Subjects and Methods: From May 2011 to May 2017, 26 children treated with the ESIN method for radial head and neck fracture, in the Department of pediatric surgery of the University hospital of Split, were retrospectively reviewed. The following parameters were analyzed for each subject: age, sex, fracture mechanism, lateralization, method of reduction, associated injury, healing time, clinical / radiological outcomes, DASH score and complications of treatment.
Results: The study covered 26 patients (15 girls, 11 boys) treated with ESIN method for fractures of radial head and neck. The average age was 9 years (5 to 16 years). The distribution of the patient with regard to the lateralization of the fracture was almost symmetric, the left arm was affected in 53.85% of the patients, and the right at 46.15%. The most common fracture mechanism was a fall on ground level (n = 9). All patients achieved healing in 5 weeks of average duration (3 – 7). The nails were removed at a median of 4 months (range, 1 to 9). The rate of complications was 11.54%, including one radial head necrosis, one angulation of 15° and one displacement of the radial head. Twenty patients (76.92%) achieved a perfect clinical healing, while 23 patients (88.46%) achieved a perfect radiological healing. The median DASH score was 1.25% (0 to 39.20%). There were no cases of delayed healing. There was one case of healing in bad position, this child was reoperated. After removing the intramedullary nails, all patients returned to full function of the extremity and all complications were resolved.
Conclusion: The ESIN method for treating fractures of the radial head and neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. The ESIN method for radial head and neck fractures is a minimally invasive, simple and reproducible technique with a low rate of complications. Due to these excellent objective and subjective results, the surgical stabilization of radial head and neck fractures using the ESIN method is recommended in children and adolescents. |
| Abstract (croatian) | Cilj istraživanja: Cilj ovog istraživanja je ustanoviti demografske i kliničke karakteristike djece operirane ESIN metodom zbog prijeloma glavice i vrata palčane kosti, analizirati ishode liječenja i stopu komplikacija, te ih usporediti s ostalim relevantnim studijama.
Ispitanici i metode: U vremenskom razdoblju od svibnja 2011. do svibnja 2017. retrospektivno su pregledane povijesti bolesti 26 djece liječene ESIN metodom zbog prijeloma glavice i vrata palčane kosti u Klinici za dječju kirurgiju Kliničkog bolničkog centra Split. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, mehanizam prijeloma, lateralizacija, način repozicije, pridružene ozljede, vrijeme cijeljenja, klinički/radiološki rezultati, DASH score i komplikacije liječenja.
Rezultati: Istraživanjem je obuhvaćeno 26 bolesnika (15 djevojčica i 11 dječaka) liječenih ESIN metodom zbog prijeloma glave i vrata palčane kosti. Prosječna dob bila je 9 godina (5- 16 godina). Raspodjela bolesnika obzirom na lateralizaciju prijeloma bila je gotovo simetrična, lijeva ruka bila je zahvaćena u 53.85% bolesnika, a desna u 46.15%. Najčešći mehanizam prijeloma bio je pad u razini (n=9). Svi bolesnici postigli su cijeljenje u srednjem vremenu od 5 tjedana (raspon 3-7). Čavli su bili uklonjeni u prosjeku od 4 mjeseca (raspon, 1-9). Stopa komplikacija bila je 11.54% uključujući jednu nekrozu glavice palčane kosti, jednu angulaciju od 15° te jedan potpuni pomak glavice palčane kosti. Dvadeset pacijenata (76.92%) postiglo je odlično kliničko cijeljenje, dok je u 23 pacijenta (88.46%) postignuto odlično radiološko cijeljenje. Srednji DASH score bio je 1.25% (raspon, 0-39.20%). Nije bilo slučajeva odgođenog cijeljenja. Dijete s potpunim pomakom glavice palčane kosti je reoperirano. Nakon uklanjanja intramedularnih čavala, svi bolesnici vratili su potpunu funkciju ektremiteta i sve komplikacije su razriješene.
Zaključci: ESIN metoda za liječenje prijeloma glavice i vrata palčane kosti u djece pokazuje jako dobre funkcionalne i kozmetičke rezultate. Omogućava mobilizaciju sa brzim smanjenjem boli. ESIN za prijelome glavice i vrata palčane kosti je minimalno invazivna, jednostavna i reproducibilna tehnika, s niskom stopom komplikacija. Zbog ovih izvrsnih objektivnih i subjektivnih rezultata, operacijska stabilizacija prijeloma glavice i vrata palčane kosti pomoću ESIN metode preporuča se u djece i adolescenata. |
