Abson Simon, Williams Nicole, Inglis Mark, Antoniou Georgia, Cundy Peter
Women's and Children's Hospital, Adelaide, Australia.
J Pediatr Orthop. 2016 Jul-Aug;36(5):478-82. doi: 10.1097/BPO.0000000000000491.
Distal third forearm fractures are one of the most common orthopaedic injuries in the pediatric population with a reported risk of redisplacement in the range of up to a third following initial reduction. The aims of this study were to determine whether fracture redisplacement and adequacy of cast molding were associated with surgeon seniority in the treatment of displaced pediatric distal third radius fractures that required manipulation under anesthesia.
This study prospectively randomized 143 pediatric patients presenting to a tertiary referral hospital with a fractured distal radius into 2 groups. We compared the surgeon seniority (resident vs. attending surgeon) with the cast index (CI) and amount of displacement/angulation postreduction.
Our results showed no significant difference in CI according to level of experience between resident and attending surgeon (P=0.14). There was also no difference in redisplacement for fracture types relative to seniority. Median redisplacement for resident and attending, respectively, for type Arbeitsgemeinschaft für Osteosynthesefragen (AO) 23E was 6% (range, 0% to 42%) versus 6% (range, 0% to 41%) P=0.98. For type AO 23M reangulation was 4 degrees (range, 0 to 29 degrees) versus 5 degrees (range, 0 to 18 degrees) P=0.97, respectively.
Our results indicate that the level of seniority does not influence the CI or redisplacement/angulation of fractures after closed reduction. Residents appear well trained in cast application.
Level I-randomized-controlled trial.
小儿尺骨远端三分之一骨折是儿科人群中最常见的骨科损伤之一，据报道，初次复位后再移位风险高达三分之一。本研究的目的是确定在需要麻醉下手法复位的小儿尺骨远端三分之一移位骨折的治疗中，骨折再移位和石膏塑形的充分性是否与外科医生的资历相关。
本研究将143名因桡骨远端骨折到三级转诊医院就诊的儿科患者前瞻性地随机分为2组。我们比较了外科医生的资历（住院医师与主治医生）与石膏指数（CI）以及复位后移位/成角的程度。
我们的结果显示，住院医师和主治医生根据经验水平在CI方面没有显著差异（P=0.14）。骨折类型的再移位相对于资历也没有差异。对于 Arbeitsgemeinschaft für Osteosynthesefragen（AO）23E型骨折，住院医师和主治医生的中位再移位分别为6%（范围0%至42%）和6%（范围0%至41%），P=0.98。对于AO 23M型骨折，再成角分别为4度（范围0至29度）和5度（范围0至18度），P=0.97。
我们的结果表明，资历水平不会影响闭合复位后骨折的CI或再移位/成角。住院医师在石膏应用方面似乎训练有素。
I级——随机对照试验。
