University of Oulu

Markus Stöckell, Tytti Pokka, Nicolas Lutz & Juha-Jaakko Sinikumpu (2021) Determining the development stage of the ossification centers around the elbow may aid in deciding whether to use ESIN or not in adolescents’ forearm shaft fractures, Acta Orthopaedica, 92:4, 461-467, DOI: https://doi.org/10.1080/17453674.2021.1912895

Determining the development stage of the ossification centers around the elbow may aid in deciding whether to use ESIN or not in adolescents’ forearm shaft fractures

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Author: Stöckell, Markus1; Pokka, Tytti1; Lutz, Nicolas2;
Organizations: 1Department of Children and Adolescents, Oulu University Hospital; PEDEGO Research Group, Oulu Childhood Fracture and Sports Injury Study, Oulu University and Oulu University Hospital; Medical Research Council, Oulu University, Oulu, Finland
2Department of Pediatric Surgery, Lausanne University Hospital, Lausanne, Switzerland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2021102752519
Language: English
Published: Informa, 2021
Publish Date: 2021-10-27
Description:

Abstract

Background and purpose: Elastic stable intramedullary nailing (ESIN) is the preferred method of operative stabilization of unstable pediatric forearm shaft fractures. However, the decision whether to use ESIN or open reduction and internal fixation (ORIF) in older children or teenagers is not always straightforward. We hypothesized that the development stage of the elbow would aid in evaluating the eligibility of the patient for ESIN.

Patients and methods: All eligible children, aged <16 years who were treated with ESIN in Oulu University Hospital, during 2010–2019 were included (N = 70). The development stages of 4 ossification centers were assessed according to the Sauvegrain and Diméglio scoring. The proportion of impaired union vs. union was analyzed according to bone maturity, by using the optimal cutoff-points determined with receiver operating characteristics (ROC).

Results: Development stage ≥ 6 in the olecranon was associated with impaired union in 20% of patients, compared with none in stages 1–5 (95% CI of difference 8% to 24%). Trochlear ossification center ≥ 4 was associated with impaired union in 17% of patients (CI of difference 7% to 36%) and lateral condyle ≥ 6 in 13% of patients (CI of difference 3.4% to 30%). Proximal radial head ≥ 5.5 was associated with impaired union in 18% of patients (CI of difference 7% to 39%).

Interpretation: Recognizing the rectangular or fused olecranon ossification center, referring to stage ≥ 6, was in particular associated with impaired fracture healing. This finding may aid clinicians to consider between ESIN and plating, when treating forearm shaft fracture of an older child or teenager.

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Series: Acta orthopaedica
ISSN: 1745-3674
ISSN-E: 1745-3682
ISSN-L: 1745-3674
Volume: 92
Issue: 4
Pages: 461 - 467
DOI: 10.1080/17453674.2021.1912895
OADOI: https://oadoi.org/10.1080/17453674.2021.1912895
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Copyright information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
  https://creativecommons.org/licenses/by/4.0/