Pediatric Forearm Fractures: TEN (Titanium Elastic Nail) versus Plate Screw Fixation for Surgical Treatment
Abstract
Background/Aims: In pediatric forearm fractures, the choice of surgical technique and fixation method can be challenging. Surgically treated pediatric patients younger than 14 years with Titanium Elastic Nails (TEN) or Plate Screw Fixation(PSF) were compared clinically, in cost, and in terms of postoperative outcomes.
Method: In the retrospective case-control study, pediatric forearm fractures operated on at a level I trauma center between 2017 and 2022 were examined. Surgically treated forearm fractures in pediatric patients under 14 years of age were included in this study group.
Results: A mean age of 10.83 +- 3.28 years was found among the 109 patients. The PSF group (12.87+-2.76 years) was 3.17 (95% CI 2.02 - 4.33) years older than the TEN group (9.7+-3 years) (p<0.001; student’s t-test). The median implant cost in the TEN group (85 [IQR 64 - 120] dollars) was significantly lower than in the PSF group (258 [IQR 205 - 336] dollars) (p<0.001; Mann-Whitney-U). The day callus tissue was observed on the X-ray differed significantly between the groups (p<0.001; chi-square test).
Conclusion: In younger children, surgeons preferred TEN due to the likelihood of remodeling associated with growth, the possibility of forming a callus sooner, and the lower cost compared to PSF
References
- Caruso G, Caldari E, Sturla FD, Caldaria A, Re DL, Pagetti P, et al. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg. 2021;105(3):225-34.
- Pace JL. Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(11):780-8.
- Yıldız C, and Erdem Y. "Çocuk önkol kırıkları." TOTBİD Dergisi 2019:375-86.
- Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. Journal of Pediatric Orthopaedics . 2010;30(4):313–9.
- Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma. 2008 Jul;65(1):109-15.
- Adam O, David VL, Horhat FG, Boia ES. Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children. Medicina (Kaunas). 2020 Feb 15;56(2):79.
- Elabd A, Khalifa R, Alam Z, Saleh ES, Thabet AM, Abdelgawad A. Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter? Adv Orthop. 2021 Oct16: 449-55.
- Dinçer R, Köse A, Topal M, Öztürk İA, Engin MÇ. Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? J Pediatr Orthop B. 2020 Mar;29(2):158-63.
- Di Giacinto S, Pica G, Stasi A, Scialpi L, Tomarchio A, Galeotti A, et al. The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment. Med Glas (Zenica). 2021 Feb 1;18(1):208-15.
- Şen Z, Sayar F, Tosun OM. "Complications and Solution Suggestıons in Situations When Implant Removal Is Required After Osteosynthesis with the Plate Screw System: Solidworks Analysis." Genel Tıp Dergisi 32.2: 47-51.
- Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B. 2016 Sep;25(5):439-46.
- Cruz AI Jr, Kleiner JE, DeFroda SF, Gil JA, Daniels AH, Eberson CP. Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012. J Child Orthop. 2017 Jun 1;11(3):201-9.
- Helenius I, Lamberg TS, Kääriäinen S, Impinen A, Pakarinen MP. Operative treatment of fractures in children is increasing. A population-based study from Finland. J Bone Joint Surg Am. 2009 Nov;91(11):2612-6
- Boia ES, David VL. The Financial Burden of Setting up a Pediatric Robotic Surgery Program. Medicina (Kaunas). 2019 Nov 14;55(11):739.
Pediatrik Ön kol Kırıklarının Cerrahi Tedavisinde TEN (Titanyum Elastik Çivi) ile Plak Vida Tespitinin karşılaştırılması
Abstract
Amaç: Pediatrik önkol kırıklarında cerrahi teknik ve tespit yöntemi seçimi zor olabilir. Titanyum Elastik Çivilerle(TEN) veya Plak Vida Tespiti(PSF) ile cerrahi olarak tedavi edilen 14 yaşından küçük pediyatrik hastalar klinik, maliyet ve postoperatif sonuçlar açısından karşılaştırıldı.
Yöntemler: Retrospektif vaka-kontrol çalışmasında 2017-2022 yılları arasında I. seviye bir travma merkezinde opere edilen pediatrik önkol kırıkları incelenmiştir. Bu çalışma grubuna 14 yaş altı pediatrik hastalarda cerrahi olarak tedavi edilen ön kol kırıkları dahil edildi.
Sonuçlar: 109 hastanın ortalama yaşı 10,83 +- 3,28 bulundu. PSF grubu (12,87±2,76 yıl), TEN grubundan (9,7±3 yıl) 3,17 (%95 GA 2,02 - 4,33) yıl daha büyüktü (p<0,001; student's t-testi). TEN grubunda medyan implant maliyeti (85 [IQR 64 - 120] dolar), PSF grubundan (258 [IQR 205 - 336] dolar) anlamlı derecede düşüktü (p<0.001; Mann-Whitney-U). Röntgende kallus dokusunun görüldüğü gün gruplar arasında anlamlı farklılık gösterdi (p<0.001; ki-kare testi).
Tartışma: Ortopedistler küçük yaştaki çocuklarda, büyüme ile ilişkili yeniden şekillenme olasılığı, daha erken bir kallus oluşturma olasılığı ve PSF ile karşılaştırıldığında daha düşük maliyet nedeniyle TEN tercih ettiler.
References
- Caruso G, Caldari E, Sturla FD, Caldaria A, Re DL, Pagetti P, et al. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg. 2021;105(3):225-34.
- Pace JL. Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(11):780-8.
- Yıldız C, and Erdem Y. "Çocuk önkol kırıkları." TOTBİD Dergisi 2019:375-86.
- Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. Journal of Pediatric Orthopaedics . 2010;30(4):313–9.
- Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma. 2008 Jul;65(1):109-15.
- Adam O, David VL, Horhat FG, Boia ES. Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children. Medicina (Kaunas). 2020 Feb 15;56(2):79.
- Elabd A, Khalifa R, Alam Z, Saleh ES, Thabet AM, Abdelgawad A. Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter? Adv Orthop. 2021 Oct16: 449-55.
- Dinçer R, Köse A, Topal M, Öztürk İA, Engin MÇ. Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed? J Pediatr Orthop B. 2020 Mar;29(2):158-63.
- Di Giacinto S, Pica G, Stasi A, Scialpi L, Tomarchio A, Galeotti A, et al. The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment. Med Glas (Zenica). 2021 Feb 1;18(1):208-15.
- Şen Z, Sayar F, Tosun OM. "Complications and Solution Suggestıons in Situations When Implant Removal Is Required After Osteosynthesis with the Plate Screw System: Solidworks Analysis." Genel Tıp Dergisi 32.2: 47-51.
- Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B. 2016 Sep;25(5):439-46.
- Cruz AI Jr, Kleiner JE, DeFroda SF, Gil JA, Daniels AH, Eberson CP. Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012. J Child Orthop. 2017 Jun 1;11(3):201-9.
- Helenius I, Lamberg TS, Kääriäinen S, Impinen A, Pakarinen MP. Operative treatment of fractures in children is increasing. A population-based study from Finland. J Bone Joint Surg Am. 2009 Nov;91(11):2612-6
- Boia ES, David VL. The Financial Burden of Setting up a Pediatric Robotic Surgery Program. Medicina (Kaunas). 2019 Nov 14;55(11):739.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Article |
| Authors | |
| Early Pub Date | June 30, 2023 |
| Publication Date | June 30, 2023 |
| Submission Date | March 1, 2023 |
| Published in Issue | Year 2023 Volume: 33 Issue: 3 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).