Department of Children and Adolescents, Division of Paediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.
Injury. 2013 Apr;44(4):431-6. doi: 10.1016/j.injury.2012.08.032. Epub 2012 Sep 15.
The incidence of paediatric forearm fractures and their invasive operative treatment is increasing. Evidence supporting increased interest in internal fixation of forearm fractures has been controversial. We studied radiographic outcome and complications of both-bone diaphyseal middle-third forearm fractures according to the type of treatment. The purpose of the study was to determine if there is an advantage in invasive treatment over non-invasive treatment that supports the increasing trend towards invasive surgery.
All children and adolescents (<16 years) with both-bone diaphyseal middle-third forearm fractures in a geographic area with 86,000 children in 2000-2009 were included. There were 168 patients. The types of primary fractures and their malalignment and displacement rates were analysed. The fractures were classified as 'severe' or 'mild' according to radiographic findings. Radiographic fracture healing and alignment and the rate of complications were compared as regards invasive versus non-invasive surgery.
Just over a third of all patients suffered from some complication during follow-up. The overall complication rate was highest in the non-invasive treatment group (58%) and lowest in the intramedullary nailing group (24%) (P < 0.001). The difference was significant as regards both mild and severe fractures. Nearly a third of the fractures in the non-invasive treatment group were re-reduced during follow-up. Two third of them were finally fixed invasively. Re-reduction after invasive fixation was rare (1.4%, P = 0.001). Re-fracture was equally uncommon (7.1%) in both the invasive and non-invasive groups. Non-union was unusual (1.2%) and it was related to high-energy trauma or chronic disease. Nerve co-morbidity, scar problems, soft-tissue complications and compartmental syndrome were not problems in the study population despite the type of treatment.
We found that the complication rate of diaphyseal forearm fractures was twice as common after non-invasive than after invasive treatment. The need of re-reduction after non-invasive treatment was remarkable. Nevertheless, bone healing was equally good despite the treatment. We conclude that intramedullary fixation of both-bone forearm fractures is a good mode of primary treatment of mild and severe middle-third diaphyseal both-bone forearm fractures.
儿童前臂骨折的发生率及其有创手术治疗呈上升趋势。支持增加前臂骨折内固定的证据一直存在争议。我们根据治疗方式研究了尺桡骨干中 1/3 双骨折的影像学结果和并发症。本研究的目的是确定有创治疗是否优于非侵入性治疗，从而支持越来越多的侵袭性手术趋势。
2000 年至 2009 年期间，在一个拥有 86000 名儿童的地理区域内，所有儿童和青少年(<16 岁)均患有尺桡骨干中 1/3 双骨折。共有 168 名患者。分析了原发性骨折的类型及其对线不良和移位率。根据影像学表现将骨折分为“严重”或“轻度”。比较了有创与非手术治疗的影像学骨折愈合、对线和并发症发生率。
随访中超过三分之一的患者发生了一些并发症。非手术治疗组的总体并发症发生率最高（58%），髓内钉组最低（24%）（P<0.001）。轻度和重度骨折均有显著差异。非手术治疗组中有近三分之一的骨折在随访中需要重新复位。其中三分之二最终采用有创固定。有创固定后再次复位的情况很少见（1.4%，P=0.001）。在侵袭性和非侵袭性组中，再骨折同样罕见（7.1%）。非愈合并不常见（1.2%），与高能创伤或慢性疾病有关。尽管治疗方式不同，但研究人群中没有神经合并症、疤痕问题、软组织并发症和筋膜间室综合征。
我们发现，非侵入性治疗后骨折的并发症发生率是非侵入性治疗后的两倍。非侵入性治疗后需要再次复位的情况非常显著。然而，尽管治疗方式不同，骨愈合情况同样良好。我们得出结论，髓内固定尺桡骨干双骨折是治疗轻度和重度尺桡骨干中 1/3 双骨折的一种较好的初始治疗方法。
