DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 90 Experience in treating unstable forearm and femur fractures in children with elastic intramedullary nail using T.... E.... N.... Bent Soloy, Steffen Skov Regionshospitalet Viborg Background: Unstable diaphyseal fractures of the forearm and femur in children often require osteosynthesis. Fractures of the forearm is often treated with k-wires or plating. Femur fractures can be treated with plaster-traction in smaller children, but in bigger children internal or external fixation is required. The use of elastic intramedullary nail is minimal invasive and seems to give sufficient stability. Purpose: To verify the good result from other international studies regarding the use of TEN for forearm fractures, and present our result in femur fractures Methods: We present our experience with TEN for unstable pediatric forearm and femur fractures. 210 patients with forearm fractures were admitted to our clinic between December 1998 and April 2010. 70 patients were treated with TEN the rest were either treated with closed reduction, K-wire our plating. 46 patients with femur fractures were admitted to our clinic between December 1998 and April 2010. 22 patients were treated with TEN. All patients in both groups were reviewed retrospectively. In the group with forearm fractures there were 38 boys and 32 girls median age 8.3 years. All fixations were protected in an above elbow plaster cast. Patients were followed up for an average of 4.2 months (range, 2-12 months). In the group with femur fractures there were 13 boys and 9 girls median age 6.9 years. All fixations were protected with a cast until radiologic union. Patients were followed for an average of 8.5 months (range 3.5-13 months). Findings: In the forearm fractures, clinical and radiologic union was achieved within 6 weeks after the procedure in 69 children. One patient was operated 1 day after the primary operation with a plat because of unacceptable angular deformity. 5 patients had superficial pin infection after 6 Weeks and had their TEN removed without any further complications. One patient had decreased subination compared to the healty side 12 months after treated with TEN, but no functional loss was reported. In the femur fractures clinical and radiologic union was achieved within 12 weeks after the procedure in 21 children. One patient was operated 2 days after primary operation with extern fixation because of unstable osteosynthesis. Two patients had a nail removed after 6 weeks because the nail irritated the skin. One patient had 2 cm leg shortening on the operated side 12 months after operation. The patient is still followed once a year to see if there will be problems with the leg. Conclusion: Diaphyseal fractures of the forearm and femur in children can be difficult to threat and often require osteosynthesis by internal or external fixation. Since 1998 our department has used a elastic intramedullary nail, T... E... N..., in these fractures with few complications and a god functionel result. 90
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 91 An uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: Clinical and radiographic 2-year follow-up Søren Kring, Michael Brix, Jacob Eschen, Ilija Ban, Anders Troelsen Aabenraa Hospital; Odense University Hospital; Hvidovre University Hospital Background: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients. The use of uncemented stems remains controversial and issues regarding inferior fixation in osteoporotic bone, implant related pain and decreased mobilization have disfavored its use. Purpose: We wished to investigate the clinical and radiographic performance at 2-year follow-up of an uncemented hydroxyapatite coated hemiarthroplasty used for DFNF. Methods: We performed a prospective, 2-year, clinical and radiographic follow-up of 97 consecutive uncemented, hydroxyapatite coated hemiarthroplasties (Corail, Depuy) operated from Dec. 06 to Dec. 07. Due to unwillingness or cognitive impairment (n=6) and death before follow-up (n=44), a total of 47 patients (39 females) with a mean age 81 years were available at follow-up. Ten of these were not available for radiographic follow-up. Findings: At 2-year follow-up 38 of 47 patients lived in their own homes and the median NMS score was 6 (range: 2-9). The median VAS pain score was 0 (range: 0- 5) at rest and 0 (range: 0-8) when walking. Patient satisfaction was 9 (range: 2-10) on the VAS scale. Anterior or lateral thigh pain or groin pain was reported by 15 patients. The EQ-5D index score at follow-up was 0.72 (range: 0.16-1.00) and the EQ-5D VAS score was 70 (range: 15-100). There were no radiographic signs of implant loosening in any of the hips. Conclusion: The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used with good clinical and radiographic results in surviving patients 2 years postoperatively. Previous speculations of compromised stem fixation and related inferior clinical results seem overrated. 91
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 90<br />
Experience in treating unstable forearm and femur<br />
fractures in children with elastic intramedullary nail<br />
using T.... E.... N....<br />
Bent Soloy, Steffen Skov<br />
Regionshospitalet Viborg<br />
Background: Unstable diaphyseal fractures of the forearm and femur in children<br />
often require osteosynthesis. Fractures of the forearm is often treated with<br />
k-wires or plating. Femur fractures can be treated with plaster-traction in smaller<br />
children, but in bigger children internal or external fixation is required. The<br />
use of elastic intramedullary nail is minimal invasive and seems to give sufficient<br />
stability.<br />
Purpose: To verify the good result from other international studies regarding<br />
the use of TEN for forearm fractures, and present our result in femur fractures<br />
Methods: We present our experience with TEN for unstable pediatric forearm<br />
and femur fractures. 210 patients with forearm fractures were admitted to our<br />
clinic between December 1998 and April 2010. 70 patients were treated with<br />
TEN the rest were either treated with closed reduction, K-wire our plating. 46<br />
patients with femur fractures were admitted to our clinic between December<br />
1998 and April 2010. 22 patients were treated with TEN. All patients in both<br />
groups were reviewed retrospectively. In the group with forearm fractures there<br />
were 38 boys and 32 girls median age 8.3 years. All fixations were protected in<br />
an above elbow plaster cast. Patients were followed up for an average of 4.2<br />
months (range, 2-12 months). In the group with femur fractures there were 13<br />
boys and 9 girls median age 6.9 years. All fixations were protected with a cast<br />
until radiologic union. Patients were followed for an average of 8.5 months<br />
(range 3.5-13 months).<br />
Findings: In the forearm fractures, clinical and radiologic union was achieved<br />
within 6 weeks after the procedure in 69 children. One patient was operated 1<br />
day after the primary operation with a plat because of unacceptable angular<br />
deformity. 5 patients had superficial pin infection after 6 Weeks and had their<br />
TEN removed without any further complications. One patient had decreased<br />
subination compared to the healty side 12 months after treated with TEN, but<br />
no functional loss was reported. In the femur fractures clinical and radiologic<br />
union was achieved within 12 weeks after the procedure in 21 children. One<br />
patient was operated 2 days after primary operation with extern fixation because<br />
of unstable osteosynthesis. Two patients had a nail removed after 6 weeks<br />
because the nail irritated the skin. One patient had 2 cm leg shortening on the<br />
operated side 12 months after operation. The patient is still followed once a year<br />
to see if there will be problems with the leg.<br />
Conclusion: Diaphyseal fractures of the forearm and femur in children can be<br />
difficult to threat and often require osteosynthesis by internal or external fixation.<br />
Since 1998 our department has used a elastic intramedullary nail, T... E...<br />
N..., in these fractures with few complications and a god functionel result.<br />
90