Open osteosynthesis in diaphyseal fractures in children with polytrauma

Abstract

BACKGROUND: The objective of the study was to appreciate the combinations of diaphyseal fractures in children, surgical methods of treatment and their results. METHODS: In a Level III trauma center we reviewed 13790 patients. Emergency trauma injuries were 33.9% (4687 children). 178 children were treated with multiple injury, which constitutes 3.7% of all children hospitalized with urgent injuries, which were performed 217 interventions. RESULTS: Diaphyseal fractures in children with politrauma in different combinations was detected in 64 children (35,9%), they were carried out 86 surgery. More commonly diaphyseal fractures were recorded combined and associated in next component humerus-humerus – 3 children (6 interventions), humerus-forearm – 10 children (12 interventions), humerus-lower thigh – 1 child, humerus-femur – 5 children (4 interventions), forearm-forearm – 6 children (8 interventions), forearm-leg – 4 children (5 interventions), femur-femur – 6 children (12 interventions), femur-femur-leg – 5 children (12 interventions), femur-leg-forearm – 2 children (2 interventions), femur-leg – 3 children (4 interventions), femur-woundsbrain trauma – 16 children (12 ostheosyntesis), leg-leg – 2 children (6 interventions), leg-brain trauma – 1 case. It was need the humeral fixation in 13 cases, 19 cases of forearm, the femur osteosynthesis 39 cases and open fractures leg 15 cases. The open fixation of humerus fractures was the fixing with three brooches clasped 8 children, with screws – 2 children and 3 cases performed by fixing metal plate and screws. To 2 children was applied external fixation device as imobilisation. The open osthosyntesis in forearm fractures was performed centro-medullary with brooches Ilizarov in 12 cases and in 7 cases performed additional cortical fixation with brooches Kirşner. Femoral intramedullary osteosynthesis with nail metal were subjected 23 children, brooches added to 5 children and 6 cases with additional fixation- screw and wire in 5 cases osteosynthesis plate and screws in leg fractures. Ostheosyntesis of leg fractures finished with Ilizarov device application to 3 children, and Gofman device in 4 children and to 6 children with pins and screws, metal plate and screws 2 children. Complications were not found. Conclusions: Osteosynthesis of diaphyseal fractures in multiple injury requires combining materials from internal and external fixation with minimal trauma, lasting attachment, so will be improved the life quality in patients with politrauma.