McQuinn Alexander Geoffrey, Jaarsma Ruurd Lukas
Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
J Pediatr Orthop. 2012 Oct-Nov;32(7):687-92. doi: 10.1097/BPO.0b013e31824b7525.
Fractures of the distal forearm and distal radius represent the most common types of fracture in the pediatric population, with the majority treated by closed reduction and cast. Redisplacement has been known to occur in up to 39% of cases. There have been numerous risk factors and radiologic indices put forward as methods of predicting redisplacement, but this topic remains a matter of debate. This retrospective study aims to further assess the significance of the many factors in redisplacement after treatment with closed reduction.
This retrospective study included 155 children with distal radius and forearm fractures. Age, sex, location of fracture, angulation, displacement, an associated ulna fracture, obliquity of fracture, and accuracy of reduction were measured for assessment as potential risk factors. In addition, the cast index, padding index, Canterbury index, second metacarpal-radius index, gap index, and 3-point index were measured on postreduction radiographs.
Redisplacement occurred in 33 of the 155 cases (21.3%). Initial displacement and accuracy of the reduction were identified as significant risk factors for redisplacement. Initial displacement of >50% (of the radius width) was significantly associated with redisplacement (odds ratio of 5.4). Failure to achieve anatomic reduction was significantly higher in the redisplacement group (odds ratio 3.9). The only radiologic index that differed significantly between groups was the cast index, with more patients without redisplacement meeting the cut-off value (60% vs. 32%, P=0.010).
Initial displacement of >50% and inability to achieve anatomic reduction are major risk factors for redisplacement. Given its effectiveness and ease of clinical application, the cast index remains the most useful measure of cast molding.
Level II--Retrospective prognostic study.
小儿人群中，前臂远端和桡骨远端骨折是最常见的骨折类型，大多数通过闭合复位和石膏固定治疗。已知高达39%的病例会发生再移位。已经提出了许多风险因素和放射学指标作为预测再移位的方法，但这个话题仍存在争议。这项回顾性研究旨在进一步评估闭合复位治疗后再移位的诸多因素的意义。
这项回顾性研究纳入了155例桡骨远端和前臂骨折的儿童。测量年龄、性别、骨折部位、成角、移位、合并尺骨骨折、骨折倾斜度和复位准确性，作为潜在风险因素进行评估。此外，在复位后的X线片上测量石膏指数、衬垫指数、坎特伯雷指数、第二掌骨-桡骨指数、间隙指数和三点指数。
155例病例中有33例（21.3%）发生再移位。初始移位和复位准确性被确定为再移位的显著风险因素。初始移位>50%（桡骨宽度）与再移位显著相关（优势比为5.4）。再移位组未实现解剖复位的比例显著更高（优势比为3.9）。两组之间唯一有显著差异的放射学指标是石膏指数，未发生再移位的患者中更多人达到临界值（60%对32%，P = 0.010）。
初始移位>50%和无法实现解剖复位是再移位的主要风险因素。鉴于其有效性和临床应用的便利性，石膏指数仍然是评估石膏塑形最有用的指标。
二级——回顾性预后研究。
