Campbell R M
University of Texas Health Science Center, San Antonio.
Orthop Clin North Am. 1990 Apr;21(2):217-43.
The indications for open treatment of skeletal injury of the pediatric hand and wrist region are limited, but failure to surgically treat these fractures and dislocations will cause later morbidity. Irreducible dislocations of the small joints of a child's hand require open reduction. Angulated fractures of the middle and proximal phalanx in the region of the neck or distal shaft also require exact reduction because of the poor remodeling capacity in that region. Irreducible Salter-Harris II fractures of the distal radius and unstable Galeazzi type fracture-dislocations of the distal radius in the older child should also be treated using open methods if a satisfactory closed reduction cannot be obtained. All treatment recommendations are based on limited case reports, and the surgeon treating such rare injuries should review the limited pertinent literature before beginning treatment of these rare injuries.
小儿手部及腕部骨骼损伤的切开治疗指征有限，但对这些骨折和脱位不进行手术治疗会导致后期发病。儿童手部小关节不可复位的脱位需要切开复位。由于该区域塑形能力差，中节和近节指骨颈部或远侧骨干的成角骨折也需要精确复位。如果大龄儿童桡骨远端Salter-Harris II型骨折无法复位，以及桡骨远端不稳定的盖氏骨折脱位，若不能获得满意的闭合复位，也应采用切开方法治疗。所有治疗建议均基于有限的病例报告，治疗此类罕见损伤的外科医生在开始治疗前应查阅有限的相关文献。
