Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Injury. 2012 Jul;43(7):1107-11. doi: 10.1016/j.injury.2012.02.020. Epub 2012 Apr 6.
Minimally displaced metaphyseal both-bone fractures of the distal forearm in children are often treated with an above-elbow cast (AEC). Treatment with a below-elbow cast (BEC) could give more comfort, but might lead to fracture displacement reducing pronation and supination. Because this has not been systematically investigated, we set up a randomised multicentre study. The purpose of this study was to find out whether BEC causes equal limitation of pronation and supination but with higher comfort level, compared with AEC.
In four hospitals, consecutive children aged<16 (mean 7.1) years with a minimally displaced metaphyseal both-bone fracture of the distal forearm were randomised to 4 weeks BEC (n=35) or 4 weeks AEC (n=31). Primary outcome was limitation of pronation and supination 6 months after initial trauma. The secondary outcomes were cast comfort, limitation of flexion/extension of wrist/elbow, complications, cosmetics, complaints, and radiological assessment.
A group of 35 children received BEC and 31 children received AEC. All children attended for the final examination at a mean follow-up of 7.0 months (range 5.0-11.6 months). Limitation of pronation and supination 6 months after initial trauma showed no significant difference between the two groups [4.4° (± 5.8) for BEC and 5.8° (± 9.8) for AEC]. Children treated with BEC had significantly higher cast comfort on a visual analogue scale [5.6 (± 2.7) vs. 8.4 (± 1.4)] and needed significantly less help with dressing (8.2 days vs. 15.1 days). Six complications occurred in the BEC group and 14 in the AEC group. Other secondary outcomes were similar between the two groups.
Children with minimally displaced metaphyseal both-bone fractures of the distal forearm should be treated with a below-elbow cast.
儿童前臂骨干骺端轻微移位骨折常采用肘上石膏固定（AEC）治疗。采用肘下石膏固定（BEC）可能会更舒适，但可能导致骨折移位，从而限制旋前和旋后。由于这尚未得到系统研究，我们进行了一项随机多中心研究。本研究的目的是确定 BEC 是否会导致相同程度的旋前和旋后受限，但舒适度更高，与 AEC 相比。
在四家医院，连续纳入年龄<16 岁（平均 7.1 岁）的前臂骨干骺端轻微双骨折的儿童，随机分为 4 周 BEC 组（n=35）或 4 周 AEC 组（n=31）。主要结局是初始创伤后 6 个月时旋前和旋后的受限程度。次要结局是石膏舒适度、腕关节/肘关节屈伸受限、并发症、外观、抱怨和影像学评估。
35 例儿童接受 BEC 治疗，31 例儿童接受 AEC 治疗。所有儿童均在平均随访 7.0 个月（5.0-11.6 个月）时接受最终检查。初始创伤后 6 个月时旋前和旋后的受限程度在两组之间无显著差异[BEC 组为 4.4°（±5.8），AEC 组为 5.8°（±9.8）]。BEC 组的石膏舒适度明显更高（视觉模拟评分 5.6（±2.7） vs. 8.4（±1.4）），穿衣时需要的帮助明显更少（8.2 天 vs. 15.1 天）。BEC 组发生 6 例并发症，AEC 组发生 14 例并发症。两组其他次要结局相似。
儿童前臂骨干骺端轻微双骨折应采用肘下石膏固定。
