Syed Arsalan Haider Bukhari.
Comparison of image assisted percutaneous intramedullary kirschner wire stenting with closed reduction for fractures of radius and ulna in children.
J Surg Pak Jan ;15(2):78-81.

Objective To evaluate the results of image assisted percutaneous intramedullary Kirschner wire stenting and closed reduction and plaster casting for displaced simple fractures of radius and ulna in children. Study design Comparative study. Place & Duration of study Department of orthopedics, Combined Military Hospital (CMH) Peshawar between June 2005 and December 2007. Methodology Forty- six children of both sexes, between the ages of 4 to 11 years with simple unilateral fractures of both forearm bones were included. Patients were divided into two groups. In group I, 24 children (Males n=15, Females n=9) were selected for treatment by image assisted closed reduction and percutaneous snugly fitting K-wire intramedullary fixation (closed reduction and internal fixation / CRIF) followed by triangular bandagae support over the dressings. In group II 22 children (Males n=13, Females n=9) were treated with image assisted closed reduction followed by POP support for the full duration (average 6 weeks) till early fracture union was achieved (closed reduction without fixation /CRWF). Selection of the patients for the two groups was done by randomising the patients with closed envelope method based on double blind technique. Results of both methods were compared. Results At a mean follow-up of 6 months, all the patients of group I displayed good functional results with an excellent recovery in the range of movements of radioulnar joints and with a notably less incidence of any residual problems. None had any angulations or nonunion, premature epiphyseal closure or residual pain. In group II residual angulations of 6 to 12 degrees was encountered in 6 children and 6 had rotational malunions. Three patients developed cross synostosis between radius and ulna. Two children had loss of 10 degrees of extension of elbow (FFD 10 degrees). Moreover the average time to regain elbow range of movements / function in these children, was found to be longer. Conclusions Image assisted closed reduction of displaced fractures of radius and ulna in children coupled with k wire intramedullary stenting was found to be a far superior option for treatment of displaced closed fractures of radius and ulna in childern as compared with closed reduction of these fractures with plaster casting only.

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