urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.5.32DDDPEHurmj-1602Research ArticleОригинальные статьи | Original articlesOriginal articlesСравнительный анализ результатов лечения переломов шейки пястных костей у детей методами антеградного и ретроградного остеосинтеза спицами КиршнераComparative Analysis of the Results of Treatment for Metacarpal Neck Fractures in Children with Antegrade and Retrograde Kirschner Wire Fixationhttps://orcid.org/0000-0003-3157-4579ГордиенкоИ. И.GordienkoI. I.

Иван Иванович Гордиенко — кандидат медицинских наук, доцент, доцент кафедры детской хирургии; травматолог-ортопед

Екатеринбург

Ivan I. Gordienko - Candidate of Sciences (Medicine), Associate Professor, Associate Professor of the Department of Pediatric Surgery

Ekaterinburg

ivan-gordienko@mail.ruhttps://orcid.org/0009-0000-3431-7813СлукинаА. Е.SlukinaA. E.

Анастасия Евгеньевна Слукина — студент педиатрического факультета

Екатеринбург

Anastasia E. Slukina - Student of the Faculty of Pediatrics

Ekaterinburg

anast.slukina@gmail.comШилинаС. А.ShilinaS. A.

Софья Андреевна Шилина — ординатор кафедры детской хирургии

Екатеринбург

Sofia A. Shilina - Resident of the Department of Pediatric Surgery

Ekaterinburg

shilina-as@yandex.ruhttps://orcid.org/0000-0001-9050-3629ЦапН. А.TsapN. A.

Наталья Александровна Цап — доктор медицинских наук, профессор, заведующий кафедрой детской хирургии; детский хирург

Екатеринбург

Natalia A. Tsap - Doctor of Sciences (Medicine), Professor, Head of the Department of Pediatric Surgery

Ekaterinburg

tsapna-ekat@rambler.ruУральский государственный медицинский университет; Детская городская клиническая больница № 9РоссияUral State Medical University; Children’s City Clinical Hospital No. 9Russian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation20241710202423532–42Copyright © Гордиенко И.И., Слукина А.Е., Шилина С.А., Цап Н.А., 20242024Гордиенко И.И., Слукина А.Е., Шилина С.А., Цап Н.А.Gordienko I.I., Slukina A.E., Shilina S.A., Tsap N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1602

Введение. Среди травм кисти доля переломов пястных костей составляет 9,6–40,0 %. В настоящее время не существует единого подхода к лечению детей с такими повреждениями.Цель — определить оптимальный метод хирургического лечения переломов пястных костей у детей путем сравнительного анализа результатов антеградного и ретроградного остеосинтеза спицами Киршнера.Материалы и методы. В проспективное когортное исследование включено 186 детей с закрытыми подголовчатыми переломами II–V пястных костей. Основная группа — 103 ребенка (55,38 %), которым выполнен антеградный остеосинтез; контрольная — 83 ребенка (44,62 %), которым спицы установлены ретроградно. На 3 и 7 сутки после операции оценивали местные воспалительные изменения. Объем активных движений в пястно-фаланговых суставах измеряли спустя 3, 6 и 12 недель.Результаты. На 3 неделе наблюдения медиана амплитуды движений в пястно-фаланговых суставах у пациентов основной группы составила 18 [13; 26] градусов, контрольной — 7 [4; 9] (p < 0,001); 6 неделе — 59 [49; 72] и 35 [32; 54] (p < 0,001); 12 неделе — 89 [84; 90] и 82 [74; 86] соответственно (p < 0,001). При макроскопической оценке области введения спиц на 3 сутки после операции отсутствие местных воспалительных изменений отмечено у 92 (89,3 %) и 73 пациентов (88,0 %) основной и контрольной групп (p = 0,953); на 7 сутки — у 100 (97,1 %) и 76 (92,5 %) соответственно (p = 0,497), однако различия не были статистически значимы.Обсуждение. Оптимальный способ лечения переломов пястных костей у детей должен быть технически простым и малотравматичным. Значимость ранней реабилитации для восстановления объема движений в суставах кисти подтверждается многими исследованиями.Заключение. Благодаря минимизации повреждений суставных поверхностей и раннему началу реабилитации в группе антеградного остеосинтеза достигнуты наилучшие функциональные результаты.

Introduction. Among hand injuries, the proportion of metacarpal fractures is 9.6–40.0 %. Currently, there is no single approach to the treatment of children with such injuries.The aim is to determine the optimal method of surgical treatment of metacarpal fractures in children by comparative analysis of the results of antegrade and retrograde osteosynthesis with Kirchner spokes.Materials and methods. A prospective cohort study included 186 children with closed head fractures of the II–V metacarpal bones. The main group consisted of 103 children (55.38 %) who underwent antegrade osteosynthesis; the control group consisted of 83 children (44.62 %) who had needles retrograde. Local inflammatory changes were assessed on the 3rd and 7th days after surgery. The volume of active movements in the metacarpophalangeal joints was measured after 3, 6 and 12 weeks.Results. At week 3 of follow-up, the median amplitude of movements in the metacarpophalangeal joints in patients of the main group was 18 [13; 26] degrees, in the control group — 7 [4; 9] (p < 0.001); at week 6–59 [49; 72] and 35 [32; 54] (p < 0.001) At week 12–89 [84; 90] and 82 [74; 86], respectively (p < 0.001). Macroscopic assessment of the needle insertion area on the 3rd day after surgery showed the absence of local inflammatory changes in 92 (89.3 %) and 73 patients (88.0 %) of the main and control groups (p = 0.953); on day 7, in 100 (97.1 %) and 76 (92.5 %), respectively (p = 0.497), however, the differences were not statistically significant.Discussion. The optimal way to treat metacarpal fractures in children should be technically simple and low-traumatic. The importance of early rehabilitation for restoring the volume of movement in the joints of the hand is confirmed by many studies.Conclusion. Due to the minimization of damage to the articular surfaces and the early start of rehabilitation, the best functional results were achieved in the antegrade osteosynthesis group.

переломкистьпястная костьинтрамедуллярный остеосинтезспица Киршнерадетиbone fracturehandmetacarpal bonesintramedullary fracture fixationbone wireschildАвторы выражают благодарность сотрудникам отделений травматологии и ортопедии № 1 и 2 Детской городской клинической больницы № 9 (Екатеринбург) за помощь в проведении исследования.The authors would like to express their gratitude to the staff of the Traumatology and Orthopedics Departments No. 1 and 2 of the Children’s City Clinical Hospital No. 9 (Ekaterinburg) for their assistance with the study.ReferencesSemenov SU, Zhila NG, Komarov KM, Komarov PB. Metacarpal fractures in children (literature review). Grekov’s Bulletin of Surgery. 2019;178(2):85–88. (In Russ). DOI: https://doi.org/10.24884/0042-4625-2019-178-2-85-88.Semenov SU, Zhila NG, Komarov KM, Komarov PB. Metacarpal fractures in children (literature review). Grekov’s Bulletin of Surgery. 2019;178(2):85–88. (In Russ). DOI: https://doi.org/10.24884/0042-4625-2019-178-2-85-88.Kiely AL, Griffin M, Jeon FHK, Nolan GS, Butler PE. Phalangeal and metacarpal fractures in children: A 10‑year comparison of factors affecting functional outcomes in 313 patients. Journal of Hand and Microsurgery. 2023;15(2):124–132. DOI: https://doi.org/10.1055/s‑0041-1730885.Kiely AL, Griffin M, Jeon FHK, Nolan GS, Butler PE. Phalangeal and metacarpal fractures in children: A 10‑year comparison of factors affecting functional outcomes in 313 patients. Journal of Hand and Microsurgery. 2023;15(2):124–132. DOI: https://doi.org/10.1055/s‑0041-1730885.Kreutz-Rodrigues L, Gibreel W, Moran SL, Carlsen BT, Bakri K. Frequency, pattern, and treatment of hand fractures in children and adolescents: A 27‑year review of 4356 pediatric hand fractures. Hand. 2022;17(1):92–97. DOI: https://doi.org/10.1177/1558944719900565.Kreutz-Rodrigues L, Gibreel W, Moran SL, Carlsen BT, Bakri K. Frequency, pattern, and treatment of hand fractures in children and adolescents: A 27‑year review of 4356 pediatric hand fractures. Hand. 2022;17(1):92–97. DOI: https://doi.org/10.1177/1558944719900565.Hartley RL, Lam J, Kinlin C, Hulin K, Temple-Oberle C, Harrop AR, et al. Surgical and nonsurgical pediatric hand fractures: A cohort study. Plastic and Reconstructive Surgery — Global Open. 2020;8(3):e2703. DOI: https://doi.org/10.1097/GOX.0000000000002703.Hartley RL, Lam J, Kinlin C, Hulin K, Temple-Oberle C, Harrop AR, et al. Surgical and nonsurgical pediatric hand fractures: A cohort study. Plastic and Reconstructive Surgery — Global Open. 2020;8(3):e2703. DOI: https://doi.org/10.1097/GOX.0000000000002703.Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016. Journal of Orthopaedic Surgery and Research. 2021;16(1):245. DOI: https://doi.org/10.1186/s13018-021-02380‑y.Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016. Journal of Orthopaedic Surgery and Research. 2021;16(1):245. DOI: https://doi.org/10.1186/s13018-021-02380‑y.Arneitz C, Bartik C, Weitzer CU, Schmidt B, Gasparella P, Tschauner S, et al. Distribution and pattern of hand fractures in children and adolescents. European Journal of Pediatrics. 2023;182(6):2785–2792. DOI: https://doi.org/10.1007/s00431-023-04915-3.Arneitz C, Bartik C, Weitzer CU, Schmidt B, Gasparella P, Tschauner S, et al. Distribution and pattern of hand fractures in children and adolescents. European Journal of Pediatrics. 2023;182(6):2785–2792. DOI: https://doi.org/10.1007/s00431-023-04915-3.Walsh LR, Nuzzi LC, Taghinia AH, Labow BI. Presentation and referral patterns in pediatric closed hand fractures. Hand. 2023;18(2):288–293. DOI: https://doi.org/10.1177/15589447211008590.Walsh LR, Nuzzi LC, Taghinia AH, Labow BI. Presentation and referral patterns in pediatric closed hand fractures. Hand. 2023;18(2):288–293. DOI: https://doi.org/10.1177/15589447211008590.Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskeletal Disorders. 2021;22(1):546. DOI: https://doi.org/10.1186/s12891-021-04436‑w.Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskeletal Disorders. 2021;22(1):546. DOI: https://doi.org/10.1186/s12891-021-04436‑w.Liao JCY, Chong AKS. Pediatric hand and wrist fractures. Clinics in Plastic Surgery. 2019;46(3):425–436. DOI: https://doi.org/10.1016/j.cps.2019.02.012.Liao JCY, Chong AKS. Pediatric hand and wrist fractures. Clinics in Plastic Surgery. 2019;46(3):425–436. DOI: https://doi.org/10.1016/j.cps.2019.02.012.Taghinia AH, Talbot SG. Phalangeal and metacarpal fractures. Clinics in Plastic Surgery. 2019;46(3):415–423. DOI: https://doi.org/10.1016/j.cps.2019.02.011.Taghinia AH, Talbot SG. Phalangeal and metacarpal fractures. Clinics in Plastic Surgery. 2019;46(3):415–423. DOI: https://doi.org/10.1016/j.cps.2019.02.011.Neumeister MW, Winters JN, Maduakolum E. Phalangeal and metacarpal fractures of the hand: Preventing stiffness. Plastic and Reconstructive Surgery — Global Open. 2021;9(10):e3871. DOI: https://doi.org/10.1097/GOX.0000000000003871.Neumeister MW, Winters JN, Maduakolum E. Phalangeal and metacarpal fractures of the hand: Preventing stiffness. Plastic and Reconstructive Surgery — Global Open. 2021;9(10):e3871. DOI: https://doi.org/10.1097/GOX.0000000000003871.Gordienko II, Tsap NA, Kutepov SM. Treatment of fractures of the main phalanx of the fingers in children. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2022;10(3):247–253. (In Russ). DOI: https://doi.org/10.17816/PTORS108751.Gordienko II, Tsap NA, Kutepov SM. Treatment of fractures of the main phalanx of the fingers in children. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2022;10(3):247–253. (In Russ). DOI: https://doi.org/10.17816/PTORS108751.Antoniadi YV. Provision of specialized medical care to trauma patients in an urban multidisciplinary hospital. Ural Medical Journal. 2022;21(2):93–96. (In Russ.). DOI: https://doi.org/10.52420/2071-5943-2022-21-2-93-96.Antoniadi YV. Provision of specialized medical care to trauma patients in an urban multidisciplinary hospital. Ural Medical Journal. 2022;21(2):93–96. (In Russ.). DOI: https://doi.org/10.52420/2071-5943-2022-21-2-93-96.Egiazaryan KA, Danilov MA, Ratyev AP, Badriev DA, Kazakov KA. Treatment of metaepypheseal fractures of the metacarpal bones. Department of Traumatology and Orthopedics. 2021;3(45):77–82. (In Russ). EDN: https://elibrary.ru/mwpdes.Egiazaryan KA, Danilov MA, Ratyev AP, Badriev DA, Kazakov KA. Treatment of metaepypheseal fractures of the metacarpal bones. Department of Traumatology and Orthopedics. 2021;3(45):77–82. (In Russ). EDN: https://elibrary.ru/mwpdes.Haddad E, Zemour M, Belkacemi Y, Al Khoury Salem H, Dohin B. L‑pinning for fifth metacarpal neck fracture in adolescents. Orthopaedics & Traumatology: Surgery & Research. 2022;108(1):102992. DOI: https://doi.org/10.1016/j.otsr.2021.102992.Haddad E, Zemour M, Belkacemi Y, Al Khoury Salem H, Dohin B. L‑pinning for fifth metacarpal neck fracture in adolescents. Orthopaedics & Traumatology: Surgery & Research. 2022;108(1):102992. DOI: https://doi.org/10.1016/j.otsr.2021.102992.Shaftel ND, Capo JT. Fractures of the digits and metacarpals: When to splint and when to repair? Sports Medicine and Arthroscopy Review. 2014;22(1):2–11. DOI: https://doi.org/10.1097/JSA.0000000000000004.Shaftel ND, Capo JT. Fractures of the digits and metacarpals: When to splint and when to repair? Sports Medicine and Arthroscopy Review. 2014;22(1):2–11. DOI: https://doi.org/10.1097/JSA.0000000000000004.Wang K, Du W, Deng C, Hu N, Zhuang W. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. Journal of International Medical Research. 2023;51(5):030006052311749. DOI: https://doi.org/10.1177/03000605231174981.Wang K, Du W, Deng C, Hu N, Zhuang W. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. Journal of International Medical Research. 2023;51(5):030006052311749. DOI: https://doi.org/10.1177/03000605231174981.Janarv PM, Wikström B, Hirsch G. The influence of transphyseal drilling and tendon grafting on bone growth: An experimental study in the rabbit. Journal of Pediatric Orthopedics. 1998;18(2):149–154. PMID: https://pubmed.gov/9531394.Janarv PM, Wikström B, Hirsch G. The influence of transphyseal drilling and tendon grafting on bone growth: An experimental study in the rabbit. Journal of Pediatric Orthopedics. 1998;18(2):149–154. PMID: https://pubmed.gov/9531394.Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K‑wire fixation in procedures involving the hand and wrist. The Journal of Hand Surgery. 2011;36(4):610–616. DOI: https://doi.org/10.1016/j.jhsa.2011.01.023.Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K‑wire fixation in procedures involving the hand and wrist. The Journal of Hand Surgery. 2011;36(4):610–616. DOI: https://doi.org/10.1016/j.jhsa.2011.01.023.Khan H, Adil A, Ul Ain N, Qureshi BA, Chishti UF, Malik TS. Outcome of buried versus exposed kirchner wires in terms of infection in fractures of phalanges and metacarpal bones of hand. Cureus. 2022;14(2): e22515. DOI: https://doi.org/10.7759/cureus.22515.Khan H, Adil A, Ul Ain N, Qureshi BA, Chishti UF, Malik TS. Outcome of buried versus exposed kirchner wires in terms of infection in fractures of phalanges and metacarpal bones of hand. Cureus. 2022;14(2): e22515. DOI: https://doi.org/10.7759/cureus.22515.Terndrup M, Jensen T, Kring S, Lindberg-Larsen M. Should we bury K‑wires after metacarpal and phalangeal fracture osteosynthesis? Injury. 2018;49(6):1126–1130. DOI: https://doi.org/10.1016/j.injury.2018.02.027.Terndrup M, Jensen T, Kring S, Lindberg-Larsen M. Should we bury K‑wires after metacarpal and phalangeal fracture osteosynthesis? Injury. 2018;49(6):1126–1130. DOI: https://doi.org/10.1016/j.injury.2018.02.027.Foucher G, Chemorin C, Sibilly A. A new technic of osteosynthesis in fractures of the distal 3d of the 5th metacarpus. La Nouvelle Presse Médicale. 1976;5(17):1139–1140. (In French). PMID: https://pubmed.gov/934828.Foucher G, Chemorin C, Sibilly A. A new technic of osteosynthesis in fractures of the distal 3d of the 5th metacarpus. La Nouvelle Presse Médicale. 1976;5(17):1139–1140. (In French). PMID: https://pubmed.gov/934828.Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clinical Orthopaedics & Related Research. 2015;473(5):1747–1754. DOI: https://doi.org/10.1007/s11999-014-4079-7.Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clinical Orthopaedics & Related Research. 2015;473(5):1747–1754. DOI: https://doi.org/10.1007/s11999-014-4079-7.Fujitani R, Omokawa S, Tanaka Y, Shigematsu K. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. Journal of Orthopaedic Science. 2012;17(4):450–456. DOI: https://doi.org/10.1007/s00776-012-0223‑y.Fujitani R, Omokawa S, Tanaka Y, Shigematsu K. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. Journal of Orthopaedic Science. 2012;17(4):450–456. DOI: https://doi.org/10.1007/s00776-012-0223‑y.Schädel-Höpfner M, Wild M, Windolf J, Linhart W. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal? Archives of Orthopaedic and Trauma Surgery. 2007;127(6):435–440. DOI: https://doi.org/10.1007/s00402-006-0254‑y.Schädel-Höpfner M, Wild M, Windolf J, Linhart W. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal? Archives of Orthopaedic and Trauma Surgery. 2007;127(6):435–440. DOI: https://doi.org/10.1007/s00402-006-0254‑y.Shen K, Xu Y, Cao D, Wang Z, Cai H. Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail. Experimental and Therapeutic Medicine. 2017;13(6):2997–3002. DOI: https://doi.org/10.3892/etm.2017.4369.Shen K, Xu Y, Cao D, Wang Z, Cai H. Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail. Experimental and Therapeutic Medicine. 2017;13(6):2997–3002. DOI: https://doi.org/10.3892/etm.2017.4369.

The authors declare that there are no conflicts of interest present.