[Evaluation of the therapeutic efficacy of retrograde diaphyseal Kirschner wire intramedullary fixation for pediatric distal radius metaphyseal-diaphyseal junction fractures].

OBJECTIVE: To explore clinical efficacy of intramedullary space-filling with retrograde Kirscher needle through epiphyseal plate in treating fractures at the distal radius metaphysis junction in children.

METHODS: A retrospective analysis was conducted on 48 children with fractures at the distal radius metaphysis junction admitted from January 2020 to December 2023, and divided into Kirchstein needle group and plate group according to different treatment methods. There were 24 patients in Kirschner's injection group, including 14 males and 10 females, aged from 6 to 14 years old with an average of(9.2±2.4) years old;15 patients on the left side and 9 patients on the right side;the time from injury to operation was 3.00 (2.25, 3.00) days;intramedullary space-occupying lesion was treated with retrograde Kirschian needle of epiphyseal plate. There were 24 patients in steel plate group, including 12 males and 12 females, aged from 6 to 13 years old with an average of (9.1±2.2) years old;14 patients on the left side and 10 patients on the right side;the time from injury to operation was 5.00 (5.00, 5.75) days;treated with open reduction and internal fixation with steel plates. Operation time, intraoperative fluoroscopy frequency, blood loss, anteroposterior and lateral angulation of X-rays before and after operation, hospital stay, and fracture healing time between two groups were compared. Gartland-Werley wrist score was used to evaluate functional recoveryat 12 months after operation.

RESULTS: All 48 patients were followed up for 12 to 23 (15.1±2.3) months. Operation time, hospital stay, fracture healing time and blood loss in Kirschner's needle group were (41.83±6.68) min, (5.50±1.00) d, (44.79±5.28) d and (14.38±5.77) mL respectively;while in steel plate groups were (53.38±8.54) min, (9.50±1.50) d, (48.42±6.14) d, and (32.29±8.34) mL respectively;Kirschner's needle group was superior to steel plate group, and the differences were statistically significant (P<0.05). The number of intraoperative fluoroscopy in Kirscher needle group was (9.25±1.54) times, which was more than that in steel plate group (6.87±1.30) times, and the difference was statistically significant (P<0.05). In Kirschner needle group, residual angulation immediately after operation was (3.21±1.50) ° on the normal position and (2.96±1.99) ° on the lateral position, at 12 months after operation, the residual angulation on the normal position (1.88±1.33) ° and the lateral position (1.88±1.23) ° was smaller than those on preoperative normal position(20.71±5.21) ° and lateral position(24.29±6.29) °;the difference were statistically significant(P<0.05);in steel plate group, the residual angulation immediately after operation was(2.58±1.28) ° on the normal position and(2.83±1.69) ° on the lateral position;at 12 months after operation, the residual angulation on normal position (2.00±1.10) ° and lateral position (2.04±1.34) ° was smaller than those on preoperative normal position(21.17±4.48) ° and lateral position(23.25±4.83) °;the difference were statistically significant(P<0.05);however, there were no statistically significant difference between two groups(P>0.05). At 12 months after operation, in Kirschner needle group, Gartland-Werley score of wrist joint was excellent in 16 patients and good in 8 patients;while 15 patients were excellent and 9 patients were good in steel plate group, there was no statistically significant difference between two groups(P>0.05).

CONCLUSION: Both of intramedullary space-occupying transepiphyseal plate and open reduction plate could achieve good therapeutic effects in the treatment of fractures at the radial metaphysis junction in children. However, transepiphyseal plate has advantages of small incision, less bleeding, less trauma, fast healing and no need for the secondary surgery.