Jordan R W, Westacott D, Srinivas K, Shyamalan G
Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK,
Eur J Orthop Surg Traumatol. 2015 Jul;25(5):841-5. doi: 10.1007/s00590-015-1627-0. Epub 2015 Apr 17.
The majority of displaced distal radius fractures are managed by closed reduction and cast immobilisation. Redisplacement is associated with initial displacement, imperfect reduction and quality of cast. The aim of this study was to establish which factors predict the risk of redisplacement.
A retrospective analysis between September 2010 and April 2013 of children who underwent closed manipulation and cast immobilisation for a distal third radius fracture was performed. Open fractures, those treated with fixation, and cases with associated dislocations or physeal injuries were excluded. Initial fracture translation and angulation, the distance from the physis and the presence of an ulna fracture were recorded. Intra-operative radiographs were analysed to assess reduction, the cast index and gap index. Clinic records and post-operative radiographs were reviewed to identify redisplacement or further surgical intervention.
During the study period, 107 children underwent closed reduction and casting: 82 boys (76.6 %) and 25 girls (23.4 %), and the mean age of the group was 10 years. Twenty-nine children (27 %) suffered a radiographic redisplacement although only five children underwent a second surgical intervention. Statistically significant risk factors for redisplacement were initial fracture translation (p < 0.001), success of reduction (p < 0.001) and associated ulna fracture (p = 0.021). Both the mean cast index (0.81 vs. 0.78) and mean gap index (0.16 vs. 0.14) were higher in the redisplaced group, but this did not reach statistical significance.
Closed reduction and immobilisation of paediatric distal radius fractures is associated with a high redisplacement rate. Initial fracture type and success of reduction are key risk factors.
大多数桡骨远端移位骨折通过闭合复位和石膏固定进行治疗。再移位与初始移位、复位不完善及石膏质量有关。本研究的目的是确定哪些因素可预测再移位风险。
对2010年9月至2013年4月间因桡骨远端三分之一骨折接受闭合手法复位和石膏固定的儿童进行回顾性分析。开放性骨折、接受内固定治疗的骨折以及伴有脱位或骨骺损伤的病例被排除。记录初始骨折的移位和成角情况、距骨骺的距离以及尺骨骨折的情况。分析术中X线片以评估复位情况、石膏指数和间隙指数。查阅临床记录和术后X线片以确定是否发生再移位或进一步的手术干预。
在研究期间，107名儿童接受了闭合复位和石膏固定：82名男孩（76.6%）和25名女孩（23.4%），该组儿童的平均年龄为10岁。29名儿童（27%）发生了影像学再移位，尽管只有5名儿童接受了二次手术干预。再移位的统计学显著危险因素为初始骨折移位（p<0.001）、复位成功情况（p<0.001）和合并尺骨骨折（p = 0.021）。再移位组的平均石膏指数（0.81对0.78）和平均间隙指数（0.16对0.14）均较高，但未达到统计学显著性。
小儿桡骨远端骨折的闭合复位和固定与较高的再移位率相关。初始骨折类型和复位成功情况是关键危险因素。
