Osteosynthesis in metaphyseal fractures in children

Abstract

Objective of study. To implement the method of fine osteosynthesis in the metaphyseal open fracture, fractures with neurovascular disturbances, intraarticular fractures. Material and methods. During 5 years in the Clinic of Orthopedics and Traumatology of the Mother’s and Child’s Institute 547 children with metaphyseal fractures were treated surgically: 75 children had proximal metaphyseal fractures of the shoulder, 290 children suffered from distal metaphyseal fractures of the arm, 35 kids were with distal metaphyseal fractures of the hip and 147 children had proximal and distal metaphyseal fractures of the thigh. The osteosynthesis was performed with Ilizarov and Kirschner pins. Results. Postoperatively plaster casts were applied for the 4-8 weeks depending on the age of the patient and of the fractured segment. Unsatisfactory results were observed in patients from vulnerable families, possibly because of not respecting the orthopedic regimen, and consisted from angular deformities after repeated traumas and inflammation around pins. Discussion. The majority of methaphyseal fractures are treated conservatively. In some cases surgery is absolutely indicated. In our clinic metaphyseal fractures are treated surgically using fine and minimally invasive osteosynthesis with pins. Osteosynthesis with pins allows adequate stabilization of the bone fragments. In children with metaphyseal fractures the osteosynthesis with Ilizarov and Kirschner pins was used, 2-4 pins depending on fractured segment, age of the patient and fracture complexity. The pins are introduced crisscross, transcutaneously and transostealy. The tactics and techniques of the surgical intervention is individualized in each case, depending on the fractured segment, type of the fracture, character of displacement, and age of patient. The external immobilization – plaster casting is applied for 4-8 weeks depending on the fractured segment and the patient’s age, and the orthopedic regimen should be strictly respected. Conclusions. 1. In metaphyseal fractures osteosynthesis should be fine and minimally invasive. 2. Using of huge metallic plates compromises the fractured segments grow. 3. The tactics and technique of surgical intervention should be individualized depending on level and type of fracture, displacement of fragments and kid’s age. 4. External cast provides perfect stability of the osteosynthesized fragments.