University of Hawaii Orthopaedics Residency Program, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, USA.
J Bone Joint Surg Am. 2012 Feb 1;94(3):246-52. doi: 10.2106/JBJS.K.00163.
Traditionally, distal radial fractures with marked displacement and angulation have been treated with closed or open reduction techniques. Reduction maneuvers generally require analgesia and sedation, which increase hospital time, cost, patient risk, and the surgeon's time. In our study, a treatment protocol for pediatric distal radial fractures was used in which the fracture was left shortened in an overriding position and a cast was applied without an attempt at anatomic fracture reduction.
Consecutive patients three to ten years of age presenting between 2004 and 2009 with a closed overriding fracture of the distal radial metaphysis were followed prospectively. Our protocol consisted of no analgesia, no sedation, and a short arm fiberglass cast gently molded to correct only angulation. Patients were followed for at least one year. All parents or guardians were given a questionnaire assessing their satisfaction with the treatment. Financial analysis was performed with use of Current Procedural Terminology codes and the average total cost of care.
Fifty-one children with an average age of 6.9 years were included in the study. Initial radial shortening averaged 5.0 mm. Initial sagittal and coronal angulation averaged 4.0° and 3.2°, respectively. The average duration of casting was forty-two days. Residual sagittal and coronal angulation at the time of final follow-up averaged 2.2° and 0.8°, respectively. All fifty-one patients achieved clinical and radiographic union with a full range of wrist motion. All parents and guardians answered the questionnaire and were satisfied with the treatment. Cost analysis demonstrated that closed reduction with the patient under conscious sedation or general anesthesia is nearly five to six times more expensive than the treatment used in this study. Adding percutaneous pin fixation increases costs nearly ninefold.
This treatment protocol presents an alternative approach to overriding distal radial fractures in children and provides the orthopaedic surgeon a simple, effective, and cost and time-efficient method of treatment.
传统上，对于明显移位和成角的桡骨远端骨折，采用闭合或切开复位技术进行治疗。复位操作通常需要镇痛和镇静，这会增加住院时间、成本、患者风险和手术医生的时间。在我们的研究中，使用了一种治疗儿童桡骨远端骨折的方案，即在重叠位置保留骨折短缩，并应用石膏而不尝试解剖复位。
连续前瞻性随访 2004 年至 2009 年间患有闭合性桡骨远端干骺端重叠骨折的 3 至 10 岁患者。我们的方案包括不使用镇痛、镇静，应用短臂玻璃纤维石膏轻柔塑形以矫正仅有的成角。对所有患者至少随访 1 年。所有家长或监护人都接受了一项评估他们对治疗满意度的问卷。采用当前操作术语（Current Procedural Terminology）代码和平均总护理成本进行财务分析。
51 名平均年龄为 6.9 岁的儿童纳入研究。初始桡骨缩短平均为 5.0mm。初始矢状面和冠状面成角分别平均为 4.0°和 3.2°。平均固定时间为 42 天。最终随访时的残余矢状面和冠状面成角分别平均为 2.2°和 0.8°。所有 51 例患者均获得临床和影像学愈合，腕关节活动度完全恢复。所有家长和监护人都回答了问卷，对治疗表示满意。成本分析表明，在清醒镇静或全身麻醉下进行闭合复位的费用几乎是本研究中治疗方法的五到六倍。增加经皮克氏针固定会使成本增加近九倍。
这种治疗方案为儿童桡骨远端重叠骨折提供了一种替代方法，为矫形外科医生提供了一种简单、有效、经济和节省时间的治疗方法。
