Clinical Study On The Treatment Of Unstable Lower Third Fractures Of Ulna And Radius In Children By Manual Reduction Combined With Percutaneous Pre-bent Kirschner Wire Fixatio

Objective: To explore the clinical effect of manual reduction combined with percutaneous pre-bending kirschner wire fixation in the treatment of unstable 1/3 distal fracture of ulna and radius in children,so as to provide relevant reference for the clinical treatment of unstable 1/3distal fracture of ulna and radius in children.Methods: From June 2021 to May 2022,84 children with unstable 1/3distal fracture of ulna and radius were randomly divided into group A(43 cases)and group B(41 cases).Group A was treated with manual reduction and external fixation with small splint,while group B was treated with manual reduction combined with percutaneous pre-bent Kirschner wire fixation combined with external fixation with small splint.The fracture healing time and VAS scores before and after treatment were recorded and compared between group A and group B.At12 weeks after operation,the wrist,elbow and forearm movements of children in group A and group B were measured,and the clinical treatment effect was evaluated according to Anderson’s evaluation criteria for forearm fracture.During the treatment and follow-up,the complications and final prognosis of children in group A and group B were recorded.Results: 82 patients were followed up effectively for 12 to 28 weeks,with an average of 18 weeks.The observation results are as follows:(1)Fracture healing time: The fracture healing time of children in group A and group B was(4.718 ± 1.050)weeks and(4.585 ± 0.670)weeks respectively,with no statistical significance(P > 0.05).(2)VAS score before and after treatment: Before treatment,2 weeks,4 weeks and 8weeks after treatment,there was no significant difference in the VAS score between group A and group B(P > 0.05);1 day after treatment,there was a significant difference in the VAS scores between group A and group B(P < 0.05).(3)Clinical efficacy evaluation: After 12 weeks,there were statistically significant differences in the wrist,elbow and forearm mobility between group A and group B(P < 0.05),According to Anderson’s evaluation criteria for forearm fracture,the clinical treatment effect was evaluated.In group A,30 cases were excellent,7cases were good,2 cases were fair and 4 cases were poor,and the excellent and good rate was 86.047%;In group B,37 cases were excellent,4 cases were good,0 cases were fair and 0 cases were poor.The excellent and good rate was 100%,the difference was statistically significant(P < 0.05).(4)Complications and prognosis: All patients in group A and group B finally healed well,and no complications such as nonunion,delayed healing,nerve injury and osteofascial compartment syndrome occurred.Complications: Group A: 1 case of skin pressure sore,1 case of abnormal healing and 7 cases of fracture re-displacement;Group B: 1 case of kirschner wire tail irritation,1 case of kirschner wire loosening.The incidence of complications in group A was 20.930%,and that in group B was 4.878%,the difference was statistically significant(P < 0.05).The patients with complications in the two groups had a good prognosis after active treatment.Conclusion:Manual reduction combined with percutaneous pre-bending kirschner wire fixation for unstable 1/3 distal fracture of ulna and radius in children has the advantages of less trauma,simple operation,strong maneuverability and fewer complications,and can be used as an ideal treatment scheme for unstable 1/3 distal fracture of radius in children.