Myositis ossificans

O2081 MALUNITED PAEDlATRIC MONTEGGIA FRACTURES

Gopalkrishna Vcrma, A. Mehta, R. Prabhoo, B.C. Kanaji, B.B. Joshi.

Jess Research and Development Centre, Mumbai (India)

Aims: Osteotomy of ulna with fractional distraction maintains ulnar length and reduced position of radial head via interrosseous membrane. Methods: We reviewed 9patients. 5:M. 4:F. aged 2-14years. Interval between injury and surgery ranged 2-36months. All had elbow deformity with radial head prominence. Restricted movement in 6patients. 3 had pain on movements. 2x2mm k-wires each, proximal and distal to ulnar osteotomy. Distal k-wires transfixed in radius in supination (during distraction of ulna, radius is pulled down). 'ZV'Transverse' osteotomy performed subperiosteally. Ulna lengthened by fractional distraction. Axial k-wire in ulna in selected patients to prevent angular deformity, developing at osteotomy site during distraction. Latency period: 7days. Distraction rate: O.Smm/day. Radial head position monitored by weekly x-rays. Static lixator time: 2x(distraction time), for consolidation ol new-bone. Total fixator time: 6weeks followed by fixator removal. Brace for 2weeks with elbow-joint physiotherapy. Results: Distraction corrected ulnar deformity, restored ulnar length and radial head in anatomical position. Average ulnar length gain: 14mm. Duration of distraction: 17days. Average follow-up: 2years (1.5 - 4years). We achieved full, painless, stable elbow flexion, extension, pronation and supination movements in eight but one patient. Pronosupination movement did not deteriorate over four years of study. No patient developed myositis ossificans or neurodeficit. 2patients had minor pin-tract infection, subsided on treatment. Conclusion: Safe, effective and fully controlled method. This technique may be considered before open procedures for radial head.

O2082 FEXIBLE INTRAMEDULLARY NAILING IN PAEDIATRIC FOREARM FRACTURES

P. Meda, V. Peter. P. Carter, N. Garg. C. Bruce.

Royal Liverpool Children NHS Trust, Altler Hey, Liverpool, U. K

Aim: To investigate the versatility of flexible intramedullary nails (FIN) in the surgical treatment of forearm fractures in children. Methods: 28 children were treated using FIN for displaced forearm fractures over a period of 5 years. There were 18 boys and 10 girls. The mean age was 11.5 years and the mean follow up were 7.9 months. Two nails were used one each for radius and ulna. 12 children were operated for unstable displaced fractures. 14 were operated after failed initial reduction and 2 were operated for open fractures. 16 were nailed by closed method. 12 had mini open technique in cases of failed initial closed reduction. The nails were removed on an average of 6-8 months. Results: all the children achieved bony union in excellent position. The average time for union was 5.6 weeks. all but 2 patients had full range of movements and none had any functional difficulty. 3 children had transient hypo aesthesia in the area of superficial radial nerve distribution and one child developed compartment syndrome which needed fasciotomy. There were no long term sequel. Conclusions: Use of FINs in paediatric forearm fractures should be encouraged when surgical intervention is needed. They are axially and rotationally stable.They are safe to introduce and remove at a later date. Their flexibility allows remodelling of the fracture and growth of the long bones.

O2083 SURGICALTREATMENT OF UNSTABLE DISPLACED FOREARM FRACTURES IN CHILDREN BY SMOOTH INTRAMEDULLARY PINS

G. Volpin, L. Lichtenstein. J. Chezar, A. Kaushanski. M. Daniel.

Dept. Orthop. Surgery, Western Galilee hospital, Naharyia, Israel

Aims: A retrospective study was performed in order to evaluate the results of fixation of displaced unstable fractures of both bones of the forearm in children by intramedullary pins. Methods: 121 children (5-16 year old: mean 11 years) with unstable displaced midshaft fractures of the forearm were treated by smooth intramedullary pin fixation. 75 (62%) were operated upon primarily because of an irreducible fracture. 46 (38%) were operated upon within 2 weeks after failed closed reduction. The arm was immobilized in a plaster cast extending above the elbow for about 6 weeks. Pins were removed between 6 weeks to 5 years (average 5.5 months). Results: Follow up (1-15 years; mean 5.5 years) was available in 91/121 children. Using the grading scheme of Price, functional results at follow up were excellent in 79/91 (87%) and good in 12/91 ( 13%).There were no fair or poor results. 80 Pts (88%) had within one year a full range of movement of the elbow and wrist joints. 11 Pts ( 12%) had an average loss of 10 degree of supination. 4 Pts. had a mild degree of angulation of the distal third of the forearm. 2 Pts had a temporary neuropraxia of the interosseous nerves. 2 Pts had re-fractures following early removal of pins. There was one case of non union treated successfully by plating. One of the patients had a delayed union of 6 months until solid healing. One had a deep wound infection. There were no other complications. Conclusions: In conclusion we found that smooth intramedullary pinning for displaced midshaft fractures of the forearm in children is a good, simple and safe method.

O2084 THE USE OF ABSORBABLE FIXATION PLATES AND SCREWS IN CHILDREN'S FOREARM FRACTURES

T.A. Beslikas. K.A. Papavasiliou. A. Sideridis, G.A. Kapetanos, V.A. Papavasiliou.

2nd Orthopaedic Depl., Aristotle University of Thessaloniki, Greece

Aims: The use of bio-absorbable fixation plates and screws, constructed of self-reinforced (SR) polylactic acid co-polymer for internal fixation of forearm fractures in children is described in this study. These plates (thickness: 1.2 mm) and screws (diameter:2.4 mm) are usually used in reconstructive surgery in the mid-face and craniofacial skeleton. Methods: Eleven patients (aged 4-12 years old), who had suffered from fractures of the distal third of the forearm (7 cases) and isolated radial fractures (4 cases), were surgically treated in our Department with absorbable fixation plates and screws, during the last 3 years. As close-reduction attempts failed in all these fractures, surgical treatment was mandatory. The general principles of internal fixation were followed in all cases. The internal fixation, with the use of these plates and screws, was reinforced with the application of a long forearm cast for a period of 4-6 weeks. Antibiotics were administered for 7 days. Results:The follow-up time ranged from 1 to 2 years. No bone or soft tissue infections were noticed post-operatively. Callus formation appeared in the expected time. Conclusions: The use of absorhable plates and screws, as a means of internal fixation, in the surgical treatment of forearm fractures in children that cannot be treated conservatively, combined with the application of a long cast, provides sufficient and adequate osteosynthesis. The use of these materials renders a second (extremely distressful for children) re-operation for the removal of metallic implants completely unnecessary.

O2085 FOREARM BOWING FRACTURES IN CHILDREN: A LONG-TERM FOLLOW-UP

P.Vorlat, H.DeBoeck.

University Hospital -V.U. B., Brussels, Belgium

Aims: To throw a new light on the fragmentary information from litera-ture, to add information to the mechanism of this injury, to clarify the cloudy treatment indications in the group between 4 and K) years and to report the outcome of conservative treatment after a mean of 80 months. Materials: After reviewing the files and X-rays, 11 children were in-eluded in this series, according to strict criteria.The decision for closed reduction depended on the severity of the deformity, on the associated lesions and on the age of the patient. At follow-up, they were subjected to a thorough anamnesis and clinical evaluation with specific concern about pain, function and cosmesis. Comparative X-rays to evaluate the remodeling were made in a standardized way. Results: The mean age at the trauma was 7 years. (4 to 12) In 3 patients, the fracture was caused by a transverse force. The diagnosis was missed 3 times. Five patients were simply put in a plaster cast, in 6 others closed reduction was performed first. In 8 patients a residual curve was accepted. After the age of 6. spontaneous remodeling was poor, with a bad cosmetic result in 1 case (residual curve of 11°) and a functional problem in at least 1 other case. Conclusions: 1. Contrary to literature, these injuries can be caused by a transverse force as well. 2. Spontaneous remodeling is far less than generally accepted. 3. Curves > 10° need reduction with an adapted technique from as early as 7 years of age on.

O2086 EMERGENCY MANAGEMENT OF PAEDIATRIC UPPER EXTREMITY TRAUMA WITH KIRSCHNER WIRES

Sharma Himanshu. G.R. Taylor. N.M.P. Clarke.

Falkirk and District Royal Infirmary, Falkirk, UK., Southampton General Hospital, Southampton

Aims: There are no large published studies examining the complication rates associated with use of Kirschner wires in fixation of a wide variety of paediatric fractures. The aim of this study is to analyse the outcomes of fracture fixation using K-wire in upper limb fractures in children and to critically assess the incidence and type of complications. Methods: This study is a retrospective review of a consecutive series of 107 fractures in 105 paediatric trauma cases treated with K-wire in between 01.09.99 to 10.09.01. Results: The fractures were fractures around Wrist (47%) and around elbow (45%). 66 (61.68%) were performed by closed percutaneous technique, 27 (25.23%) by open method and in 14 (13.08%) combined approach was used. Around there were 13 cases with over-granulation at wound site, 6 cases of Soft tissue infection, 2 cases with tendinitis, 1 case of Osteo-myelitis and 1 case with hyper-sensitive scar. 3 cases found to have post-operative neurapraxia and 1 case with axonotmesis. Metal migration was detected in 4 cases and 14 cases found to have shown wire loosening. 10 fractures have lost position in post-operative period out of which 2 cases were reoperated for Re K-wire, 1 had undergone Re-MUA and 7 left for remodelling. Conclusions: K-wires are versatile but are not inherently benign. We conclude that best results could be achieved if total life of K-wire can be restricted to 3-4 weeks. We recommend one should explain all these risks and complications during consenting for K-wiring procedures.

O2088 THE TREATMENT OF BUCKLE FRACTURES IN A BANDAGE: A PROSPECTIVE RANDOMISEDTRIAL

S. West, J. Andrews, A. Bebbington. O. Ennis, P. Alderman.

Department Orthopaedics, Royal Gwent Hospital, Newport, South Wales, UK

Aims: To show that the treatment of buckle fractures in children in a soft bandage, rather than a plaster cast, is an effective and safe method of treatment. Methods: In order to determine the difference between the two groups it was decided to compare the range of movement at three weeks. Power calculations were performed. This gave a required sample size of 23 for each group. The project was submitted for ethical approval in july 1999. Patients enter the trial after parents agree and sign the consent form. Allocation to either plaster or bandage is random and parents draw previously sealed envelopes themselves. Patients are seen each week and measurements taken of their range of movement. Results: Thirty seven patients have completed the study. 17 have been allocated to bandage the rest to cast. Those in bandage show an excellent range of movement at the first week with no reported problems on their questionnaires. One patient has transferred from bandage to plaster at the request of the parents. Conclusion: Results suggest a positive result for treatment in bandage with no reported adverse effects and, a highly desirable result for the patient. We would hope to suggest a change in treatment policy for such fractures.

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