Schulte Daniel, Habernig Sandra, Zuzak Tycho, Staubli Georg, Altermatt Stefan, Horst Maya, Garcia Daniel
Department of Pediatric Surgery, University Children's Hospital Zürich, Zürich, Switzerland.
Department of Pediatric Radiology, University Children's Hospital Zürich, Zürich, Switzerland.
Eur J Pediatr Surg. 2014 Apr;24(2):163-7. doi: 10.1055/s-0033-1341412. Epub 2013 Mar 14.
Fractures of the forearm are the most common fractures in children. Various methods of cast immobilization have been recommended. Currently, there is still controversy regarding the optimal method of treatment, especially regarding the need for cast splitting.
We conducted a single-center randomized and controlled trial between June 2008 and September 2009. Children younger than 16 years presenting to the emergency department with a closed fracture of the forearm needing reduction were eligible for random assignment to immobilization in a closed or split circumferential semirigid cast. The primary outcome was the incidence of cast-related soft-tissue problems such as compartment syndrome, neurovascular compromise, saw burns, or skin breakdown. The secondary outcome was fracture stability.
During this period, 100 patients were randomly assigned to one of the two procedures and analyzed. Follow-up was completed in 99 patients. No compartment syndrome was observed in either group. Moderate skin breakdown (< 2 cm(2)) occurred in two patients, one in the closed cast and one in the split cast group. Secondary splitting was necessary in one patient because of a reversible lymphedema. Significant secondary displacement of the fracture was slightly more common in the split group (5 of 50 patients [10%] vs. 4 of 49 patients [8%] in the closed cast group) without reaching statistical significance.
No significant difference in the incidence of cast-related problems was observed between the groups. Fracture stability was comparable in both groups. We suggest that closed circumferential semirigid casts are a safe and effective immobilization technique for fractures of the forearm in children and splitting can be omitted.
前臂骨折是儿童最常见的骨折类型。已经推荐了各种石膏固定方法。目前，关于最佳治疗方法仍存在争议，尤其是关于是否需要切开石膏。
我们在2008年6月至2009年9月期间进行了一项单中心随机对照试验。年龄小于16岁、因闭合性前臂骨折需复位而到急诊科就诊的儿童有资格被随机分配到闭合或切开的环形半刚性石膏固定组。主要结局是与石膏相关的软组织问题的发生率，如骨筋膜室综合征、神经血管损伤、锯伤或皮肤破损。次要结局是骨折稳定性。
在此期间，100例患者被随机分配至两种治疗方法之一并进行分析。99例患者完成随访。两组均未观察到骨筋膜室综合征。两名患者出现中度皮肤破损（<2 cm²），一名在闭合石膏组，一名在切开石膏组。一名患者因可逆性淋巴水肿需要再次切开。骨折明显的二次移位在切开组略更常见（切开组50例患者中有5例[10%]，闭合石膏组49例患者中有4例[8%]），但未达到统计学意义。
两组之间与石膏相关问题的发生率无显著差异。两组的骨折稳定性相当。我们建议闭合环形半刚性石膏是儿童前臂骨折安全有效的固定技术，可省略切开操作。
