Abstract
Background: In unstable metaphyseal and diaphyseal forearm fractures the treatment of choice
is percutaneous Kirschner wire (K-wire) fixation or elastic stable intramedullary
nailing (ESIN), respectively. The optimal treatment for the diametaphyseal transition
zone is still a matter of debate.
Methods: The diametaphyseal transition zone was defined as the square over the “physis of
distal radius and ulna” minus the square of “physis of distal radius alone”. Transepiphyseal
intramedullary K-wire fixation was performed in unstable fractures affecting this
transitional area. The operative, postoperative and functional outcomes were assessed
and compared to previously treated patients who were treated using other techniques
(plate, external fixator or ESIN).
Results: 10 patients received transepiphyseal intramedullary K-wire fixation. Additionally
the ulna was stabilized by antegrade ESIN in 5 cases. Cast immobilization was performed
for 39, sports restriction for 43 and metal removal was done after 50 days. No complications,
bone malalignment, or functional deficits occurred (mean follow-up: 17 months). 13
patients were treated using alternative options. 3 patients had plates with cast immobilization
for 26 days, sports restriction for 63 and metal removal after 287 days. 5 patients
were treated by external fixation for 54 days. Their sports restriction was 73 days.
The remaining 5 patients had ESIN. In 1 of these cases additional cast immobilization
was necessary. Their sports restriction was 51 days and metal removal was done after
88 days. In 4 cases a malalignment >10° of the radius was documented, and 1 patient
had a functional deficit of forearm pro-/supination.
Conclusion: Transepiphyseal intramedullary K-wire fixation in unstable diametaphyseal forearm
fractures is a minimally invasive, quick and technically easy treatment option but
requires additional immobilization. Our data suggest that this technique offers advantages
compared to alternative treatment options.
Key words
pediatric trauma - forearm - diametaphysis - intramedullary nailing - Kirschner wire
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Correspondence
Dr. Justus Lieber
University Children's Hospital
Department of Pediatric Surgery
Hoppe-Seyler-Straße 1
D-72076 Tübingen
Germany
Phone: +49 7071 29 86621
Fax: +49 7071 29 4046
Email: mail@justus-lieber.de
