Sinikumpu Juha-Jaakko, Serlo Willy
Department of Paediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.
J Pediatr Orthop B. 2015 May;24(3):200-6. doi: 10.1097/BPB.0000000000000162.
The incidence of forearm shaft fractures in children has increased in recent years. They are challenging to treat and they can result in several long-lasting complications. The treatment of children's fractures needs to be individualized to their needs. Nonoperative care will be satisfactory for young, preschool children and it is primarily treatment in stable fractures of children at every age. Injury mechanism must be understood to perform appropriate closed reduction. Immobilization using a long-arm cast needs to be focused against the deforming muscle forces - in particular those that rotate - in the forearm, keeping the bones in alignment until bone healing. Operative stabilization by elastic stable intramedullary nailing is the primarily method of treatment in cases of unstable fractures, in particular, in children between preschool age and adolescence. For older children near to skeletal maturity, a rigid plate and screw fixation will be justified. The most common complication after closed treatment is worsening of the alignment and need for repetitive interventions. elastic stable intramedullary nailing results usually in good outcome, and range of forearm rotation is the main feature determining the clinical result. In this article, we report the current concept of paediatric shaft fractures in the radius and ulna.
近年来，儿童前臂骨干骨折的发病率有所上升。这类骨折治疗起来颇具挑战性，可能会导致多种长期并发症。儿童骨折的治疗需要根据其具体需求进行个体化处理。对于年幼的学龄前儿童，非手术治疗通常就足够了，而且它也是各年龄段儿童稳定骨折的主要治疗方法。必须了解损伤机制才能进行恰当的闭合复位。使用长臂石膏固定时，需要重点对抗前臂中导致变形的肌肉力量，尤其是那些产生旋转的力量，使骨骼保持对线直至骨折愈合。对于不稳定骨折，尤其是学龄前儿童至青少年阶段的儿童，弹性稳定髓内钉内固定术是主要的治疗方法。对于接近骨骼成熟的大龄儿童，采用坚固的钢板螺钉固定是合理的。闭合治疗后最常见的并发症是对线情况恶化，需要反复干预。弹性稳定髓内钉固定术通常能取得良好效果，前臂旋转范围是决定临床疗效的主要因素。在本文中，我们报告了儿童桡骨和尺骨骨干骨折的当前治疗理念。
