Monga Puneet, Raghupathy Anantakrishna, Courtman Nigel H
Furness General Hospital, Barrow-in-Furness, Cumbria, UK.
J Pediatr Orthop B. 2010 Mar;19(2):181-7. doi: 10.1097/BPB.0b013e3283314646.
Children's forearm fractures treated in plaster after closed reduction can redisplace and require remanipulation. A retrospective review of 164 consecutive manipulations of fractures of radius and ulna in theatre over a 3-year period was carried out. After various exclusions, 114 patients entered the study. The overall rate of remanipulation was 14.04% (16 children). Presence of preoperative translation deformity predisposed to loss of position in plaster (P<0.0001). Residual deformity on intraoperative films also had a strong adverse influence on the outcome (P = 0.001). Usage of below-the-elbow plaster in distal fractures (P = 0.840), having a low cast index (P = 0.538), fracture of both radius and ulna (P = 0.248), site of the fracture (P = 0.048, not significant on logistic regression) or surgeon grade (P = 0.744) did not have any significant bearing on the rate of manipulation. We propose that fractures with preoperative translation where anatomical reduction is not achieved should be fixed internally.
闭合复位后采用石膏治疗的儿童前臂骨折可能会再次移位，需要再次手法复位。对3年内连续在手术室进行的164例桡骨和尺骨骨折手法复位进行了回顾性研究。经过各种排除后，114例患者进入研究。再次手法复位的总体发生率为14.04%（16名儿童）。术前存在平移畸形易导致石膏固定后位置丢失（P<0.0001）。术中X线片上的残余畸形对结果也有强烈的不利影响（P = 0.001）。在远端骨折中使用肘下石膏（P = 0.840）、低石膏指数（P = 0.538）、桡骨和尺骨双骨折（P = 0.248）、骨折部位（P = 0.048，在逻辑回归中无显著性）或外科医生级别（P = 0.744）对再次手法复位率均无显著影响。我们建议，对于术前存在平移且未实现解剖复位的骨折，应进行内固定。
