Erasmus Medical Center, Department of Orthopaedic Surgery, Postbox 2040, 3000 CA, Rotterdam, The Netherlands.
Injury. 2013 Apr;44(4):498-503. doi: 10.1016/j.injury.2012.11.001. Epub 2012 Dec 3.
Displaced metaphyseal both-bone fractures of the distal forearm are generally reduced and stabilised by an above-elbow cast (AEC) with or without additional pinning. The purpose of this study was to find out if re-displacement of a reduced stable metaphyseal both-bone fracture of the distal forearm in a child could be prevented by stabilisation with Kirschner wires.
Consecutive children aged <16 years with a displaced metaphyseal both-bone fracture of the distal forearm (n = 128) that was stable after reduction were randomised to AEC with or without percutaneous fixation with Kirschner wires. The primary outcome was re-displacement of the fracture.
A total of 67 children were allocated to fracture reduction and AEC and 61 to reduction of the fracture, fixation with Kirschner wires and AEC. The follow-up rate was 96% with a mean follow-up of 7.1 months. Fractures treated with additional pinning showed less re-displacement (8% vs. 45%), less limitation of pronation and supination (mean limitation 6.9 (± 9.4)° vs. 14.3 (± 13.6)°) but more complications (14 vs. 1).
Pinning of apparent stable both-bone fractures of the distal forearm in children might reduce fracture re-displacement. The frequently seen complications of pinning might be reduced by a proper surgical technique.
儿童的远端前臂骨干骺端双骨折一般通过肘上石膏（AEC）固定或附加克氏针固定来实现复位和稳定。本研究旨在探讨克氏针固定是否可以预防儿童已复位稳定的远端前臂骨干骺端双骨折再移位。
连续纳入 128 例儿童（年龄<16 岁），他们均存在移位的远端前臂骨干骺端双骨折，骨折复位后稳定。这些儿童被随机分配到接受 AEC 固定或接受 AEC 固定联合经皮克氏针固定。主要结局为骨折再移位。
67 例患儿接受了骨折复位和 AEC 固定，61 例患儿接受了骨折复位、克氏针固定和 AEC 固定。随访率为 96%，平均随访时间为 7.1 个月。附加克氏针固定的骨折再移位发生率较低（8% vs. 45%），旋前和旋后受限程度较轻（平均受限 6.9°±9.4° vs. 14.3°±13.6°），但并发症更多（14 例 vs. 1 例）。
在儿童中，附加克氏针固定看似稳定的远端前臂骨干骺端双骨折可能会降低骨折再移位的发生率。通过适当的手术技术，可以减少克氏针固定常见的并发症。
