Osteosynthesis in multiple fractures in children

Abstract

Objective of study. To estimate the surgical treatment tactics and technique in multiple fractures in children in order to improve results. Material and methods. Over the past 25 years 131 children with multiple fractures of long bones received specialized treatment in the pediatric orthopedic clinic. There was prevalence of male patients (59.5%) aged over 10 years (65.6%). Of the total number of children, 294 fractures were assessed. Of them, 81 femoral fractures, 66 forearm fractures, 65 leg fractures, 60 arm fractures and others. Fractures due to road accidents prevailed (over 52%). After clinical and laboratory examinations carried out in intensive care unit and necessary preparation, the children were subjected to surgery under general anesthesia in order to appropriately reposition fragments and to perform osteosynthesis (except 29 fractures without displacement of fragments). Results. In metaphyseal, epi-metaphyseal, epiphyseal, and metaphyseal-diaphyseal fractures osteosynthesis was performed with Kirschner pins through cross insertion. In all operated cases fragments were consolidated without complications. Intramedullary osteosynthesis with metal rods, especially elastic ones was used in transversal diaphyseal fractures of the femur and forearm; while in oblique and spiroid diaphyseal fractures, osteosynthesis was additionally associated with cerclage wiring. Stable osteosynthesis was performed with the external Ilizarov apparatus in diaphyseal fractures of the leg. In diaphyseal humeral fractures, osteosynthesis was performed with elastic rods or Ilizarov pins, using the principles of TEN method. In open fractures, after primary surgical wound treatment, osteosynthesis was performed with pins or external devices. Discussions. The outcomes of surgical treatment in multiple fractures directly depend on the location of fractures, the quality of surgery, compliance with the requirements of biological osteosynthesis with endosteal and periosteal protection. We consider inadmissible to perform on children osteosynthesis with massive screwed plates as well as major removal of periosteum from bone. Conclusion. The basic treatment in multiple fractures is the surgical one, being carried out in one stage in the following order: open fractures, intra-articular fractures, fractures of the femur, leg, upper arm, forearm; biological minitraumatic osteosynthesis.