Schmuck T, Altermatt S, Büchler P, Klima-Lange D, Krieg A, Lutz N, Muermann J, Slongo T, Sossai R, Hasler C
District Hospital Langenthal, Department of Orthopaedics, Langenthal, Switzerland.
Eur J Pediatr Surg. 2010 Sep;20(5):316-20. doi: 10.1055/s-0030-1255038. Epub 2010 Jun 24.
Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity, particularly at the forearm diaphysis. The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few.
Aim of this study was to determine the factors which predispose to refracture and deformities, and to define therapeutic strategies.
We prospectively gathered clinical and radiographic data over a period of one year on greenstick fractures of the middle third of the forearm in children as part of a multi-centre study. Endpoint was a follow-up visit at one year. Radiographic deformity, state of consolidation at resumption of physical activities and refracture rate were analysed statistically (ANOVA, Student's t-test and Pearson's chi-square test) with regard to patient age, gender, fracture type, therapy and time in plaster.
We collected the data of 103 patients (63 boys, 40 girls), average age 6.6 years (1.3-14.5 years), the vast majority of whom had a combined greenstick fracture of the radius and ulna. 6.7% of the patients sustained a refracture within 49 days (29-76) after plaster removal. They were significantly older (p=0.017) with a significantly higher incidence of manual completion of the fracture with radiographic signs of partial consolidation (p=0.025). Residual deformities were significantly smaller after completion of the fracture compared to reduction without completion (p=0.019) or plaster fixation alone (p<0.005).
Completion of a greenstick fracture does not prevent refracture. Nevertheless, it diminishes the extent of secondary deformities in cases where the primary angulation exceeds the remodelling capacity. Prevention of refracture should include a routine radiographic follow-up 4-6 weeks after injury with continuation of plaster fixation in cases of partial consolidation.
生长期间发生的青枝骨折再骨折和创伤后畸形风险高，尤其是在前臂骨干处。通过手法处理凹侧皮质来预先完成骨折的做法存在争议，支持该方法的数据较少。
本研究旨在确定易导致再骨折和畸形的因素，并确定治疗策略。
作为一项多中心研究的一部分，我们前瞻性地收集了一年期间儿童前臂中1/3青枝骨折的临床和影像学数据。终点是一年后的随访。就患者年龄、性别、骨折类型、治疗方法和石膏固定时间，对影像学畸形、恢复体力活动时的骨愈合状态和再骨折率进行了统计学分析（方差分析、学生t检验和皮尔逊卡方检验）。
我们收集了103例患者（63例男孩，40例女孩）的数据，平均年龄6.6岁（1.3 - 14.5岁），其中绝大多数为桡骨和尺骨联合青枝骨折。6.7%的患者在拆除石膏后49天内（29 - 76天）发生再骨折。他们年龄显著更大（p = 0.017），骨折手法整复且有部分骨愈合影像学征象的发生率显著更高（p = 0.025）。与未完成整复的复位（p = 0.019）或单纯石膏固定（p < 0.005）相比，骨折完成整复后的残留畸形显著更小。
青枝骨折的整复并不能预防再骨折。然而，在初始成角超过重塑能力的情况下，它能减小继发畸形的程度。预防再骨折应包括在受伤后4 - 6周进行常规影像学随访，对于部分骨愈合的情况继续进行石膏固定。
