DOS 2016

DOS Kongressen 2016 ·

237

Surgical approach for elastic stable intramedullary

nail (ESIN) in pediatric radius shaft fracture

– A systematic review

Nørgaard Sandra Lohne, Riber Sara Schødt, Danielsson Frederik Borup, Pedersen

Niels Wisbech, Viberg Bjarke Løvbjerg

Department of Orthopaedic Surgery and Traumatology, Odense University

Hospital

Background:

When using elastic stable intramedullary nailing (ESIN) in chil-

dren’s forearm shaft fractures the surgical approach in the distal radius can ei-

ther be lateral or dorsal.

Purpose / Aim of Study:

The aim was to conduct a systematic review with

meta-analysis to compare the lateral approach (LA) and dorsal approach (DA) in

terms of complications when treating pediatric radius shaft fractures.

Materials and Methods:

On October 14th 2015 an electronic search of

PubMed, Embase and Cochrane databases was performed. Two authors inde-

pendently screened 2234 articles by title, abstract and finally full text of 104

eligible articles was read. Data on demographics and complications was extract-

ed by one author and checked by a second author. Complications were grouped

into minor (temporary) or major (permanent or additional surgery) complica-

tions. The quality of studies was assessed according to Risk of Bias Assessment

Tool for Nonrandomized Studies. Due to the lack of studies directly comparing

the two approaches, a meta-analysis could not be performed.

Findings / Results:

Sixteen studies (1502 patients) used LA while six studies

(416 patients) used DA. There were four prospective studies, 18 retrospec-

tive, and the median follow-up ranged from 4.5-54. The quality of the included

studies was in general low with high risk of bias and many studies lacked report-

ing of complications. Concerning major complications deep infection was 0.3%

for LA and 6.3% (1 study) for DA, 0.3% permanent nerve palsy for LA, and

2.6% tendon rupture for DA. Concerning minor complications superficial infec-

tion was 2.6% for LA and 1.9% for DA, transient nerve palsy 2,9 % for LA and

5.3% for DA.

Conclusions:

When deciding between LA and DA for radius shaft fractures

treated with ESIN one should consider a 0.3% permanent nerve palsy for LA

compared to 2.6% tendon rupture for DA.

No conflicts of interest reported

188.