Reinhardt Keith R, Feldman David S, Green Daniel W, Sala Debra A, Widmann Roger F, Scher David M
Hospital for Special Surgery, New York, NY 10021, USA.
J Pediatr Orthop. 2008 Jun;28(4):403-9. doi: 10.1097/BPO.0b013e31816d71f2.
When operative stabilization of forearm fractures in older children is necessary, the optimal method of fixation is controversial. This study compared the radiographic and functional outcomes of intramedullary nailing to plating of forearm fractures in children between 10 and 16 years of age.
Thirty-one patients who underwent operative fixation of midshaft radius and ulna fractures were divided into nailing and plating groups and were compared retrospectively according to perioperative data and patient outcome measures (fracture union at 3 and 6 months, loss of forearm rotation, restoration of radial bow magnitude and location, and complication rates).
The nailing group had 19 patients, with a mean age of 12.5 years (range, 10-14.6 years), and the plating group had 12, with a mean age of 14.5 years (range, 11.9-16 years). Groups were similar for sex, arm injured, fracture location, Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association classification, and number of open fractures. Duration of surgery and tourniquet use were significantly shorter in the nailing group (P = 0.037 and 0.001, respectively). No differences were found between the groups for fracture union at 3 or 6 months. At latest follow-up, radial bow magnitude was similar for the 2 groups and restored to normal in both. Radial bow location in the nailing group was significantly different from the reported normal values (P = 0.001). Despite this, there was no difference in loss of forearm rotation between groups. Complication rates were also similar between groups, with 1 ulna nonunion, 1 compartment syndrome, and 2 refractures in the nailing group and 1 radius and ulna nonunion, 1 broken plate, and 2 refractures in the plating group.
Based on similar functional and radiographic outcomes, nailing of length-stable forearm fractures remains an equally effective method of fixation in skeletally immature patients 10 to 16 years of age when compared with plating and is our treatment of choice.
Therapeutic level III--retrospective comparative study.
对于大龄儿童前臂骨折进行手术稳定固定时，最佳固定方法存在争议。本研究比较了10至16岁儿童前臂骨折髓内钉固定与钢板固定的影像学和功能结果。
31例行桡骨干和尺骨干骨折手术固定的患者被分为髓内钉固定组和钢板固定组，并根据围手术期数据和患者预后指标（3个月和6个月时骨折愈合情况、前臂旋转丧失、桡骨弓大小和位置的恢复情况以及并发症发生率）进行回顾性比较。
髓内钉固定组有19例患者，平均年龄12.5岁（范围10 - 14.6岁），钢板固定组有12例，平均年龄14.5岁（范围11.9 - 16岁）。两组在性别、受伤手臂、骨折部位、AO/OTA分类以及开放性骨折数量方面相似。髓内钉固定组的手术时间和止血带使用时间显著更短（分别为P = 0.037和0.001）。两组在3个月或6个月时骨折愈合情况无差异。在最近一次随访时，两组桡骨弓大小相似且均恢复正常。髓内钉固定组的桡骨弓位置与报道的正常值有显著差异（P = 0.001）。尽管如此，两组在前臂旋转丧失方面无差异。两组并发症发生率也相似，髓内钉固定组有1例尺骨不愈合、1例骨筋膜室综合征和2例再骨折，钢板固定组有1例桡骨和尺骨不愈合、1例钢板断裂和2例再骨折。
基于相似的功能和影像学结果，对于10至16岁骨骼未成熟患者，长度稳定的前臂骨折髓内钉固定与钢板固定相比仍是同样有效的固定方法，是我们的首选治疗方法。
治疗性III级——回顾性比较研究。
