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首页> 外文期刊>Annals of King Edward Medical University. >A COMPARATIVE STUDY OF INCIDENCE OF IATROGENIC ULNAR NERVE INJURIES IN TWO DIFFERENT TECHNIQUES OF CROSS KIRSCHNER WIRE CONFIGURATION FOR FIXATION OF PAEDIATIC SUPRACONDYLAR FRACTURES OF HUMERUS
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A COMPARATIVE STUDY OF INCIDENCE OF IATROGENIC ULNAR NERVE INJURIES IN TWO DIFFERENT TECHNIQUES OF CROSS KIRSCHNER WIRE CONFIGURATION FOR FIXATION OF PAEDIATIC SUPRACONDYLAR FRACTURES OF HUMERUS

机译：两种不同的克氏针交叉固定技术治疗肱骨CON上S骨折中医源性尺神经损伤的比较研究

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Abstract Objective: The objective of this study was to com-pare the incidence of iatrogenic ulnar nerve injuries in two different techniques of cross Kirschner wire configuration for the fixation of paediatric supracon-dylar fractures of humerus. Methodology: Forty patients attending Accident and Emergency Department of The Children's Hospital and Institute of Child Health, Lahore, with supracon-dylar fracture of humerus were studied from September 2014 to March 2015 to compare the incidence of iatrogenic ulnar nerve injuries in two techniques of cross Kirschner wire configuration for the fixation of supracondylar fractures of humerus. These patients were divided in group A and group B. Each group consisted of 20 patients. The fracture of patients in group A was fixed with two lateral cross Kirschner wires configuration and fracture of patients in group B was fixed with mediolateral cross Kirschner wires con-figuration. All the operations were performed by same team of Paediatric orthopaedic surgeons. Technique of Kirschner wire fixation of the fracture was allocated to the patients randomly. Informed consent was taken from parents of the patient. Detailed history of the patient was taken and thorough clinical examination including evaluation of neuromuscular status of the injured limb was done and recorded. Complete blood counts and urine analysis were done. Preoperative antibiotics were administered intravenously. In general anaesthesia, closed reduction of the fracture was done under C arm x-ray image intensifier control, fracture was held reduced manually and fixed with percuta-neous Kirschner wires according to the fixation techni-que allocated to the patient. The Kirschner wires were bent, cut, buried under the skin, aseptic dressing and plaster back slab was applied. After recovery from general anaesthesia neurovascular status of the limb was re-evaluated and check x-rays of the elbow were done. Next day, the patient was discharged from the hospital and examined clinically and radiologically at 3 weeks, 6 weeks and 12 weeks. Results: In this comparative study of incidence of iatrogenic ulnar nerve injuries in two different techni-ques of cross Kirschner wire configuration for fixation of paediatric supracondylar fractures of humerus, the peak incidence of the fractures was between the age of 5 - 7 years. There were 28 (70%) males and 12 (30%) were females with male to female ratio of 2.3:1. Nine (23%) patients sustained injury at home, 7 (17%) pat-ients during cycling, 22 (55%) patients during playing and 2 (5%) fell from height. Right side was fractured in 14 (35%) patients and left side was fractured in 26 (65%) patients. One patient (5%) had flexion type of fracture and 39 patients (95%) had extension type of fracture. According to Gartland classification 5 (13%) had type II and 34 (87%) had type III fractures. In gro-up A, in which the fracture was fixed with two lateral cross Kirschner wire configuration none of the patients had iatrogenic ulnar nerve injury. In group B, 1 (5%) patient in which fracture was fixed with mediolateral cross Kirschner wire configuration, an iatrogenic ulnar nerve injury was observed which completely recove-red in 6 weeks with physiotherapy. Conclusion: Techniques of two lateral cross Kirs-chner wire configuration and mediolateral cross Kirs-chner wire configuration are equally effective for fix-ation of paediatric supracondylar fracture of humerus. But mediolateral cross configuration technique can cause iatrogenic ulnar nerve injury. Therefore, it is concluded that two lateral cross Kirschner wire techni-que is a safe method for fixation of paediatric supra-condylar fractures of humerus in terms of iatrogenic ulnar nerve injury.
机译：摘要目的：本研究的目的是比较两种不同的克氏针交叉构形用于固定小儿肱骨dy上骨折的医源性尺神经损伤的发生率。方法：2014年9月至2015年3月，对40名就诊于拉合尔儿童医院急诊科和儿童健康研究所急诊科的肱骨con上骨折的患者进行了比较，比较了两种交叉技术对医源性尺神经损伤的发生率Kirschner线配置用于固定肱骨con上骨折。这些患者分为A组和B组。每组由20名患者组成。 A组患者的骨折采用两根横向克氏针钢丝固定，B组患者的骨折以中外侧克氏针钢丝固定。所有手术均由小儿整形外科医生的同一团队执行。将克氏针固定骨折的技术随机分配给患者。知情同意书来自患者的父母。记录患者的详细病史，并进行彻底的临床检查，包括评估受伤肢体的神经肌肉状况，并进行记录。完成全血细胞计数和尿液分析。术前静脉注射抗生素。在全身麻醉中，在C臂X射线图像增强器的控制下完成骨折的闭合复位，手动保持骨折复位，并根据分配给患者的固定技术用经皮柯氏钢丝固定。将Kirschner线弯曲，切割，埋在皮下，使用无菌敷料和抹灰石膏板。从全身麻醉恢复后，重新评估肢体的神经血管状态，并检查肘部的X射线。第二天，患者出院并在3周，6周和12周时进行临床和放射学检查。结果：在本项比较性研究中，采用两种不同的克氏针交叉线技术固定小儿con上肱骨骨折的医源性尺神经损伤发生率，该骨折的峰值发病年龄在5-7岁之间。男28例（70％），女12例（30％），男女之比为2.3：1。九名（23％）患者在家中受伤，骑自行车时有7名患者（17％），游戏期间有22名（55％）患者，其中2名（5％）从高处摔下。右侧骨折14例（35％），左侧骨折26例（65％）。 1例（5％）为屈曲型骨折，39例（95％）为伸展型骨折。根据Gartland的分类，其中5例（13％）为II型骨折，34例（87％）为III型骨折。在A组中，骨折用两条横向交叉的克氏针固定，无一例医源性尺神经损伤。在B组中，有1名（5％）的患者骨折已通过中外侧交叉克氏针钢丝固定，观察到医源性尺神经损伤，经理疗在6周内完全消失。结论：两种侧向交叉Kirs-chner线配置和内侧侧交叉Kirs-chner线配置的技术在固定小儿con上sup上骨折方面同样有效。但是中外侧交叉配置技术会导致医源性尺神经损伤。因此，可以得出结论，就医源性尺神经损伤而言，两条横向交叉克氏针技术是一种固定小儿肱骨sup上突骨折的安全方法。

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