Chia Benjamin, Kozin Scott H, Herman Martin J, Safier Shannon, Abzug Joshua M
Resident, Department of Orthopaedics, University of Maryland, Baltimore, Maryland.
Instr Course Lect. 2015;64:499-507.
Distal radius and forearm fractures represent a large percentage of pediatric fractures. The most common mechanism of injury is a fall onto an outstretched arm, which can lead to substantial rotational displacement. If this rotational displacement is not adequately addressed, there will be resultant loss of forearm motion and subsequent limitations in performing the activities of daily living. Good initial reductions and proper casting techniques are necessary when treating distal radius and forearm fractures nonsurgically; however, maintaining an acceptable reduction is not always possible. Atraumatic reduction of a displaced physeal fracture should occur within 7 days of the injury. If an impending malunion presents at 2 weeks or later after injury, observation is warranted because of concerns about physeal arrest with repeated attempts at manipulation, and it should be followed by a later assessment of functional limitations. Pediatric patients and their parents have higher expectations for recovery, which has contributed to an increase in the surgical management of pediatric distal radius and forearm fractures. In addition, surgical interventions, such as intramedullary nailing, have their own associated complications.
桡骨远端和前臂骨折在儿童骨折中占很大比例。最常见的损伤机制是跌倒时手掌伸展着地，这可能导致明显的旋转移位。如果这种旋转移位没有得到充分处理，将会导致前臂活动丧失，并进而限制日常生活活动。非手术治疗桡骨远端和前臂骨折时，良好的初始复位和正确的石膏固定技术是必要的；然而，维持可接受的复位并非总是可行的。移位的骨骺骨折应在受伤后7天内进行无创复位。如果在受伤后2周或更晚出现骨愈合不良，由于担心反复手法复位会导致骨骺早闭，因此应进行观察，并随后对功能受限情况进行评估。儿科患者及其父母对康复的期望更高，这导致了儿童桡骨远端和前臂骨折手术治疗的增加。此外，诸如髓内钉固定等手术干预也有其自身相关的并发症。
