Nado Bukvić1, Marin Marinović2, Bore Bakota3, Ana Bosak Veršić4, Robert Karlo5, Ante Kvesić6, Nadomir Gusić7, Miran Čoklo8, Frane Bukvić9. 1. Department of Paediatric Surgery, University Hospital Rijeka, Rijeka, Croatia. Electronic address: nado.bukvic@optinet.hr. 2. Department of Surgery, University Hospital Rijeka, Rijeka, Croatia. 3. Department of Surgery, General Hospital Karlovac, Karlovac, Croatia. 4. Department of Paediatric Surgery, University Hospital Rijeka, Rijeka, Croatia. 5. Department of Paediatric Surgery, General Hospital Zadar, Zadar, Croatia. 6. Department of Paediatric Surgery, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina. 7. Department of Surgery, General Hospital Pula, Pula, Croatia. 8. Institute for Anthropological Research, Zagreb, Croatia. 9. School of Medicine, University of Zagreb, Zagreb, Croatia.
Abstract
BACKGROUND: Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications. PATIENTS AND METHODS: A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years. RESULTS: A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1cm. CONCLUSION: Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
BACKGROUND: Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications. PATIENTS AND METHODS: A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years. RESULTS: A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1cm. CONCLUSION: Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
Authors: Jonatas Brito DE Alencar Neto; Amanda Progênio Dos Santos; Guthierrez Victor DE Abreu Bezerra; Luiz Holanda Pinto Neto; Maria Luzete Costa Cavalcante Journal: Acta Ortop Bras Date: 2022-01-28 Impact factor: 0.513