Schlickewei W, Oberle M
Abteilung Unfall- und Wiederherstellungschirurgie, Kindertraumatologie, Regionalverbund Kirchlicher Krankenhäuser, St. Josefskrankenhaus, Freiburg.
Unfallchirurg. 2005 Mar;108(3):223-32; quiz 233-4. doi: 10.1007/s00113-005-0924-1.
Fractures of the forearm in children are quite frequent injuries, treated in emergency rooms. Most of them occur during leisure or sport activities. Most cases are monotraumatic. The diagnosis can be made by a conventional x-ray examination of the forearm in two planes. It is possible to differentiate between stable fractures (greenstick fractures) and unstable (dislocated) fractures. The first-line therapy for stable fractures or fractures which can be reduced anatomically correctly, is the conservative procedure using a long arm cast. Axial dislocation up to 20 degrees (age <5 years) or up to 10 degrees (age >5 years) can be accepted. Special cases, such as Monteggia or Galeazzi fractures, must be considered. Unstable fractures have to be reduced during surgical stand-by. The state of the art in surgical therapy is intramedullary nailing with titanium elastic nails. Open fractures and fractures with severe soft tissue injuries can be treated with external fixation. Osteosynthesis with plates should only be used for special indications. By following therapeutic principles, a successful outcome can be achieved and later complications are rare.
儿童前臂骨折是急诊室常见的损伤。其中大多数发生在休闲或体育活动期间。大多数病例为单一创伤。通过对前臂进行常规的双平面x光检查即可做出诊断。可以区分稳定骨折（青枝骨折）和不稳定（脱位）骨折。对于稳定骨折或能够正确解剖复位的骨折，一线治疗方法是采用长臂石膏进行保守治疗。轴向脱位达20度（年龄<5岁）或达10度（年龄>5岁）是可以接受的。必须考虑特殊情况，如孟氏骨折或盖氏骨折。不稳定骨折必须在手术准备期间进行复位。外科治疗的最新技术是使用钛弹性髓内钉进行髓内钉固定。开放性骨折和伴有严重软组织损伤的骨折可采用外固定治疗。钢板内固定仅适用于特殊适应症。遵循治疗原则，可取得成功的治疗效果，后期并发症也很少见。
