Injury - 2026-04-01 - Journal Article
Proximal forearm antegrade elastic stable intramedullary nailing for pediatric distal radius metaphyseal-diaphyseal junction fractures: A modified technique.
Zheng B, Feng W, Geng L, Jiang K
Topics
Key Takeaway
Antegrade ESIN reduced open reduction rate from 36.6% to 10.5% and achieved excellent/good forearm rotation in 92.1% vs 65.9% compared to retrograde crossed K-wires for pediatric distal radius MDJ fractures.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective study compared proximal-forearm antegrade ESIN versus retrograde crossed K-wire fixation for pediatric distal radius metaphyseal-diaphyseal junction fractures in 79 children. A-ESIN demonstrated significantly lower open reduction rates (10.5% vs 36.6%, P=0.007), earlier cast removal (25.1 vs 39.4 days, P<0.001), and superior excellent/good rates for both forearm rotation (92.1% vs 65.9%, P=0.006) and wrist flexion-extension (97.4% vs 70.7%, P=0.003). Complication profile favored A-ESIN with one superficial infection versus eight complications in the R-KW group including two physeal injuries and one transient radial nerve palsy.
Key Limitation
Retrospective design without randomization means fracture complexity and surgeon selection bias cannot be excluded as confounders driving the observed outcome differences.
Original Abstract
BACKGROUND
Distal radius metaphyseal-diaphyseal junction (MDJ) fractures in children are technically demanding, and the optimal fixation strategy remains controversial. The clinical performance of proximal-forearm antegrade elastic stable intramedullary nailing (A-ESIN) was compared with conventional retrograde crossed Kirschner-wire fixation (R-KW).
METHODS
This retrospective study included 79 children treated for distal radius MDJ fractures at [blinded for review] between January 2018 and April 2024, with a minimum follow-up of 12 months. Thirty-eight underwent A-ESIN and 41 received R-KW fixation. Intraoperative variables (operative time, blood loss, fluoroscopic exposures, open-reduction rate), postoperative recovery (time to cast removal, time to implant removal, excellent/good rates of forearm rotation and wrist flexion-extension), radiographic alignment, and complications were analyzed.
RESULTS
Compared with R-KW, A-ESIN resulted in lower blood loss (3.8 ± 2.8 mL vs 5.6 ± 4.1 mL; P = 0.024) and a reduced need for open reduction (10.5 % vs 36.6 %; P = 0.007). Casts were removed earlier (25.1 ± 2.0 days vs 39.4 ± 6.9 days; P < 0.001). Excellent/good functional outcomes were more frequent for forearm rotation (92.1 % vs 65.9 %; P = 0.006) and wrist flexion-extension (97.4 % vs 70.7 %; P = 0.003). Radiographic alignment was excellent/good in 84.2 % of A-ESIN cases versus 65.9 % of R-KW cases (P = 0.048). Fewer complications occurred with A-ESIN (one superficial wound infection) than with R-KW (five pin-tract infections, one transient radial-nerve palsy, two redisplacements, and two physeal injuries).
CONCLUSIONS
Proximal-forearm A-ESIN is a less invasive, more stable technique that expedites functional recovery and lowers complication rates relative to retrograde crossed K-wires. It represents a safe and effective alternative for managing pediatric distal radius MDJ fractures.