Bochang Chen, Katz Kalman, Weigl Daniel, Jie Yang, Zhigang Wang, Bar-On Elhanan
Orthopedic Department, Shanghai Children's Medical Center and Shanghai 2nd Medical University, Shanghai, China.
J Child Orthop. 2008 Jun;2(3):217-20. doi: 10.1007/s11832-008-0101-5. Epub 2008 Apr 26.
A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China.
The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15 degrees ) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal.
Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15 degrees on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients.
On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical examination does not show signs of nonunion or malalignment, no radiographic examination is necessary.
采用前瞻性汇总病例系列研究，评估以色列和中国主要大学儿科医学中心对儿童闭合性前臂骨折进行频繁影像学检查在治疗中的价值。
样本包括202例连续的非手术治疗的闭合性前臂骨折儿童（平均年龄7岁；范围3 - 12岁）。开放性骨折、生长板骨折或合并附近关节脱位的骨折（即孟氏骨折）患儿被排除。28例青枝骨折患儿在石膏拆除时（治疗开始3周后）进行了影像学检查。63例稳定骨折（无需复位，即无移位或轻度移位、完全骨折或青枝骨折）患儿在治疗开始1周后进行了影像学检查，并在4 - 6周后石膏拆除时再次检查。其余111例完全骨折、移位骨折或青枝骨折（均伴有大于15度的成角）且接受闭合复位的患儿，在石膏固定后2周额外进行了一次X线检查。所有患儿（除青枝骨折患儿外）在石膏拆除后临床随访3个月，未进行进一步的影像学检查。
石膏拆除时的X线片显示所有稳定骨折均愈合良好，表明拆除石膏时额外的X线检查并无附加价值。在不稳定骨折患儿中，仅9例在石膏固定后的前2周内复查X线片时出现大于15度成角的再移位。所有9例均成功进行了再次复位。石膏拆除后3个月的临床评估显示，样本中的所有患者肘部和前臂活动均正常。所有患者均未发生再次骨折。
基于这些结果，对于青枝骨折或完全骨折，建议在石膏固定后2周进行X线检查。在石膏拆除时，如果临床检查未显示骨不连或畸形排列的迹象，则无需进行影像学检查。
