Treatment of epiphyseo-metaphyseal fractures in children with an original implant. The threaded pin with an adjustable lock (Fixano).
OBJECTIVE
Improvement of stability of internal fixation of epiphyseo-metaphyseal fractures in children with an implant characterized by its small diameter, easy utilization and its versatility. It avoids the drawbacks of screw fixation particularly in respect to the growth plate.


METHODS
Potentially all epiphyseo-metaphyseal fractures in children.


METHODS
None. Crossing of the growth cartilage by small pins (< 2 mm) is without consequences under the condition that no compression is applied and that correction of a faulty pin position is limited to one.


METHODS
In general, two threaded pins are used. They are inserted in a divergent fashion after the fracture has been reduced. Percutaneous insertion is possible. An adjustable lock screwed on a special key is slid over the end of the pin and put in contact with bone. It is squeezed until the key breaks off. The pins are then shortened.


RESULTS
Since November 1999 these pins have been used for six olecranon fractures. In January 2002 we extended the indication to other fracture sites. Between January 2002 and July 2003 this system has been used 37 times (six olecranon fractures, eleven lateral condylar fractures and 13 medial epicondylar fractures of the elbow, and seven fractures of the ankle). A total of 43 fractures were treated (20 girls, 23 boys, average age 9.8 +/- 3.6 years) Average duration of follow-up 16.8 +/- 4.7 months. The assessment of results was based on technical, radiographic, and functional aspects. The overall results were good, in particular in respect to the stability of implants and the functional results. No secondary displacement, nor nonunion were observed; the pins were removed in all children at 6 weeks. The ease of handling the implants and the good clinical and radiologic results led us to propose these pins for routine use in epiphyseal and epiphyseo-metaphyseal fractures in children. Some improvements, however, are indicated principally, in particular in respect to the control of compression achieved by the adjustable lock.
Gicquel
Philippe
P
Abteilung für Kinderorthopädie, Krankenhaus Hautepierre, Louis-Pasteur-Universität, Strassburg, Frankreich. philippe.gicquel@chru-strasbourg.fr
Giacomelli
Marie-Christine
MC
Karger
Claude
C
Clavert
Jean-Michel
JM
D001858:Bone Nails; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000601:surgery*; D006132:Growth Plate / Q000601:surgery*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D000072042:Salter-Harris Fractures; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000601:surgery