Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures – a retrospective multicentre study

Abstract

Background Distal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius (AO 23r-M/3.1) and forearm (AO 23-M/3.1) fractures in children operated on with K-wires versus a novel technique with bioresorbable implants. Methods We retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5–12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 24 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one and half year. Results There was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group. Conclusions Surgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

Distal Radius Fractures in Childhood - Our Five-Year Experience

“…Within a retrospective multicentre study in Hungary during the period between January 2019 and January 2020 of 26 children aged between five and 12 years with severely displaced distal metaphyseal radial fractures, six patients are treated with biodegradable poly(L-lactide)-co-glycolide acid implants (Bioretec®, ActivaPin®), while 13 children are treated with one or two stainless steel Kirschner-wires (Sanatmetal®) buried under the skin and seven ones are managwed with Kirschner-wires left outside the skin (Varga et al, 2022). In the first group, the complication rate is statistically significantly lower and no second surgical intervention is required.…”

Resorbable implants in paediatric orthopaedics and traumatology

“…Varga et al [13] published a comparative study of the treatment of 94 distal fractures of the radius, associated or not with ulna fractures. One group treated with one or two stainless steel Kirschner wires which were buried under the skin (n = 40), a second group with K-wire left outside (n = 24) and the third group with an original technique of distal radial elastic nailing with bioresorbable PLGA pins (n = 30).…”

Determination of risk factors for instability in pediatric distal radius fractures

“…Poor molding and overfilling of the cast is a known cause of a loose-fitting cast which may lead to repositioning [5]. Most surgeons recommend osteosynthesis if the fracture is unstable after reduction [6]. Proctor et al [7] suggested fixation in all cases where perfect reduction could not be achieved, while Prevot et al [8] recommended wire fixation for unstable or irreducible fractures.…”