Sinikumpu Juha-Jaakko, Pokka Tytti, Serlo Willy
Clinic of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Eur J Pediatr Surg. 2013 Aug;23(4):289-96. doi: 10.1055/s-0032-1333116. Epub 2013 Feb 26.
Forearm fractures are common among children. Unlike most pediatric fractures, there is a risk of unsatisfactory results in forearm shaft fractures. The healing of a tubular bone is most unlikely in the diaphysis far away from the metaphyseal zones. The treatment of forearm shaft fractures is evolving. The purpose of the study was to analyze the pattern of forearm shaft fractures and their treatment in a population of children in recent years.
All the children (from 0 to 16 years) with a both-bone forearm shaft fracture (AO-segment 22-D) during the years 1997 to 2009 in a catchment area of about 86,000 children were included in this population-based study. There were 291 fractures in all. The age-related annual incidences, background factors, seasonal variation, injury types, treatment, reoperations, and short-term outcome were determined.
The incidence of all forearm shaft fractures increased threefold in 1997 to 2009 (p < 0.001). Boys predominated (70%) over the girls (p < 0.001). The mean age of the patients was 8.7 years (SD, +/- 3.8) among both genders. The fractures were most common in August and most uncommon in December (p < 0.001). A fall in the playground was the most common type of injury (34%). Ninety-two percent of all patients (N = 269) were treated in the operating room and 44% (N = 119) were invasively stabilized. The incidence of invasive surgery held stable. However, elastic stable intramedullary nailing (ESIN) increased from 10% in 1998-2000 to 30% in 2007-2009 (p = 0.043). There were 77 reoperations (26%); reoperation rate was 5% (6/119) and 41% (N = 71/172) in the invasive and non-invasive treatment groups, respectively. Twenty-three percent of the patients referred did not have better than "good" short-term results. The "excellent" short-term outcome was increasing (p = 0.031).
We found two mega-trends in pediatric forearm shaft fractures in the period from 1997 to 2009: First, the number of fractures was increasing significantly. Second, the forearm shaft fractures were increasingly treated by an invasive intramedullary method. We also found a significant seasonal variation, but the reason for it is not clear. The findings are based on valuable population-based data and the results are certain. Pediatric trauma centres should prepare themselves for on-going changes in forearm shaft fractures.
前臂骨折在儿童中很常见。与大多数儿科骨折不同，前臂骨干骨折存在预后不佳的风险。远离干骺端区域的骨干管状骨极难愈合。前臂骨干骨折的治疗方法在不断发展。本研究的目的是分析近年来儿童群体中前臂骨干骨折的类型及其治疗情况。
本基于人群的研究纳入了1997年至2009年期间在一个约有86,000名儿童的集水区内所有患有双骨前臂骨干骨折（AO分型22-D）的儿童（年龄从0至16岁）。共有291例骨折。确定了年龄相关的年发病率、背景因素、季节变化、损伤类型、治疗方法、再次手术情况和短期预后。
1997年至2009年期间，所有前臂骨干骨折的发病率增加了两倍（p < 0.001）。男孩占主导（70%），高于女孩（p < 0.001）。男女患者的平均年龄为8.7岁（标准差，±3.8）。骨折在8月最为常见，在12月最不常见（p < 0.001）。在操场摔倒 是最常见的损伤类型（34%）。所有患者中的92%（N = 269）在手术室接受治疗，44%（N = 119）采用侵入性固定。侵入性手术的发生率保持稳定。然而，弹性稳定髓内钉固定（ESIN）从1998 - 2000年的10%增加到2007 - 2009年的30%（p = 0.043）。有77例再次手术（26%）；侵入性和非侵入性治疗组的再次手术率分别为5%（6/119）和41%（N = 71/172）。转诊患者中有23%的短期预后未优于“良好”。“优秀”的短期预后在增加（p = 0.031）。
我们发现1997年至2009年期间儿童前臂骨干骨折有两个大趋势：第一，骨折数量显著增加。第二，前臂骨干骨折越来越多地采用侵入性髓内方法治疗。我们还发现了显著的季节变化，但其原因尚不清楚。这些发现基于有价值的基于人群的数据，结果是确定的。儿科创伤中心应做好准备应对前臂骨干骨折的持续变化。
