Lieber Justus, Schmittenbecher Peter
Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany.
Department of Pediatric Surgery, Municipal Hospital, Karlsruhe, Baden-Württemberg, Germany.
Eur J Pediatr Surg. 2013 Dec;23(6):427-33. doi: 10.1055/s-0033-1360460. Epub 2013 Dec 10.
Shaft fractures of the long bones are among the most common pediatric injuries. They are characterized by a limited potential for spontaneous correction because of the fractures--distance to the physis. Although conservative treatment has been practiced for many years with satisfying results, several aspects have led to an increase in the numbers of surgical procedures including changes of living, sports habits, economics, and patients-request to treatment. We reviewed the literature to describe developments of treatment concepts of pediatric shaft fractures. In shaft fractures of the upper extremities, increasing rates of surgical procedures have been reported preventing functional deficits of forearm prosupination and cosmetic deformities of the humerus. In fractures of the lower extremities maximizing stability shifted into the focus of interest to achieve early mobilization and to compensate heavier body weights of children and adolescents. Consecutively, the current gold standard of pediatric shaft fracture treatment--ESIN (elastic stable intramedullary nailing)--has been modified repeatedly using end caps, prebended nails, and optimized surgical techniques. In addition, new methods such as rigid locking nails and plates have been included in the treatment approaches for femur and tibia shaft fractures. All these methods of pediatric fracture care carry inherent advantages that require consideration for each clinical situation. On the other side, this has enlarged the spectrum of potential complications, which needs continuous evaluation to further improve treatment results.
长骨干骨折是最常见的儿科损伤之一。由于骨折部位与骨骺的距离，其自发矫正的潜力有限。尽管保守治疗已应用多年且效果令人满意，但包括生活方式、运动习惯、经济状况以及患者对治疗的要求等多个方面，导致了手术治疗数量的增加。我们回顾了相关文献，以描述儿童骨干骨折治疗理念的发展。在上肢骨干骨折中，据报道手术治疗率不断上升，以预防前臂旋前功能障碍和肱骨的外观畸形。在下肢骨折中，最大化稳定性成为关注焦点，以实现早期活动并应对儿童和青少年较重的体重。相应地，儿童骨干骨折治疗的当前金标准——弹性髓内钉固定术（ESIN）——已多次通过使用端帽、预弯钉和优化手术技术进行改良。此外，诸如刚性锁定钉和钢板等新方法已被纳入股骨干和胫骨干骨折的治疗方法中。所有这些儿童骨折治疗方法都有其固有的优点，需要针对每种临床情况加以考虑。另一方面，这也扩大了潜在并发症的范围，需要持续评估以进一步改善治疗效果。
