Extensor Tendon Injury Associated With Dorsal Entry Flexible Nailing of Radial Shaft Fractures in Children: A Report of 5 New Cases and Review of the Literature

Murphy, Hamadi; Jain, Viral V.; Parikh, Shital N.; Wall, Eric J.; Cornwall, Roger; Mehlman, Charles T.

doi:10.1097/bpo.0000000000000897

Cited by 14 publications

(16 citation statements)

References 28 publications

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“…The overall complication rate for intramedullary nails ranges from 17 to 42% [ 10 ]. They include infection in the site of implant, skin irritation, tendon injury (for example Extensor Pollicis Longus rupture has been reported as a result of friction with sharp nail ends) [ 38 , 49 , 50 ], nerve injury [ 51 ], implant migration, bursitis, hypertrophic scars, synostosis, refracture after removal [ 52 ], nonunion [ 38 , 53 ], delayed union [ 54 ] and compartment syndrome. This one is associated with longer operative times, longer tourniquet times, open fractures, surgery on the day of injury, younger age [ 55 , 56 ].…”

Section: Surgical Indicationmentioning

confidence: 99%

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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Purpose This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option. Methods We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review. Results Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation. Conclusions There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.

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Section: Surgical Indicationmentioning

confidence: 99%

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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“…Moreover, as observed in one of our cases, nails that require dorsal insertion via Lister's tubercle are at risk of developing an EPL tendon injury. [8,27]…”

Section: Discussionmentioning

confidence: 99%

Is there a standard treatment for displaced pediatric diametaphyseal forearm fractures?

Kubiak

Aksakal

Weiß³

et al. 2019

Medicine

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To review our institutional results and assess different surgical and non-surgical techniques for the treatment of displaced diametaphyseal forearm fractures in children and adolescents. Thirty-four children (25M, 9F) with a total of 36 diametaphyseal forearm fractures who underwent treatment under general anesthesia between July 2010 and February 2016 were recruited to this retrospective study. From October 2016 until March 2018 patients and/or parents were contacted by telephone and interviewed using a modified Pediatric Outcomes Data Collection Instrument (PODCI). Median age at the time of injury was 9.1 years (range, 1.9–14.6 years). Initial treatment included manipulation under anesthesia (MUA) and application of plaster of Paris (POP) (n = 9), elastic stable intramedullary nailing (ESIN) (n = 10), percutaneous insertion of at least one Kirschner wire (K-wire) (n = 16), and application of external fixation (n = 1). Eleven children (32%) experienced a total of 22 complications. Seven complications were considered as major, including delayed union (n = 1) and extensor pollicis longus (EPL) tendon injury (n = 1) following ESIN, as well as loss of reduction (n = 2) and refractures (n = 3) after MUA/POP. The median follow-up time was 28.8 months (range, 5.3–85.8 months). In 32 out of 34 cases (94%) patients and/or parents were contacted by telephone and a PODCI score was obtained. Patients who experienced complications in the course of treatment had a significantly lower score compared with those whose fracture healed without any sequelae ( P = .001). There was a trend towards an unfavorable outcome following ESIN compared with K-wire fixation ( P = .063), but not compared with POP ( P = .553). No statistical significance was observed between children who were treated initially with a POP and those who had K-wire fixation ( P = .216). There is no standard treatment for displaced pediatric diametaphyseal forearm fractures. Management with MUA/POP only is associated with an increased refracture rate. Based on our experience K-wire fixation including intramedullar positioning of at least one pin seems to be favorable compared with ESIN.

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“…Awareness should be raised for an increased risk of EPL rupture with this fixation method [21]. In order to avoid direct injury to the tendon using this technique, surgeons are advised to operate by advancing laterally, which is a safer alternative regarding EPL injuries [22]. Another possible cause of delayed EPL rupture is due to the tendon irritation over a protruding nail end following elastic nailing [23].…”

Section: Epl Rupture In Pediatricsmentioning

confidence: 99%

Pediatric Extensor Pollicis Longus Tendon Rupture after Nondisplaced Distal Radius Fracture: A Literature Review

Truong¹,

Kuklova²,

Halpern³

et al. 2020

AOASM

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The purpose of this article is to review the literature related to extensor pollicis longus tendon rupture following nondisplaced distal radius fractures in the pediatric population. This injury is more commonly seen in adults and is relatively rare in children and adolescents. In our literature search, only one case report of pediatric extensor pollicis longus rupture after nondisplaced displaced distal radius fracture is reported. Therefore, it is possible that anatomic and physiologic differences in pediatric patients may be protective against the physical irritation and ischemia thought to cause this injury in their adult counterparts. More research, including biomechanical studies and vascular studies, ought to be done to evaluate for the physiologic differences in pediatric patients that may account for the decreased risk of extensor pollicis longus rupture after nondisplaced distal radius fractures.

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Extensor Tendon Injury Associated With Dorsal Entry Flexible Nailing of Radial Shaft Fractures in Children: A Report of 5 New Cases and Review of the Literature

Abstract: Level III-therapeutic.

Cited by 14 publications

References 28 publications

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Is there a standard treatment for displaced pediatric diametaphyseal forearm fractures?

Pediatric Extensor Pollicis Longus Tendon Rupture after Nondisplaced Distal Radius Fracture: A Literature Review

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