Joeris Alexander, Lutz Nicolas, Blumenthal Andrea, Slongo Theddy, Audigé Laurent
a AO Clinical Investigation and Documentation , Dübendorf.
b Department of Pediatric Surgery, Traumatology and Orthopedics , University Hospital (Inselspital) Bern.
Acta Orthop. 2017 Apr;88(2):123-128. doi: 10.1080/17453674.2016.1258532. Epub 2016 Nov 24.
Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods - We included children and adolescents (0-17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results - Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation - The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome.
背景与目的——为在处理儿童长骨骨折时达成共识，2007年引入了AO儿童长骨骨折综合分类法（AO PCCF）。作为其最终验证的一部分，我们展示了根据PCCF分类的具有代表性的儿童群体上肢中最相关的骨折类型。患者与方法——我们纳入了2009年1月至2011年12月期间在瑞士伯尔尼和洛桑的大学医院被诊断患有1处或多处长骨骨折的儿童和青少年（0至17岁）。对患者病历进行回顾性审查，并根据标准X线片对骨折进行分类。结果——在2203名儿童和青少年的2292例上肢骨折中，26%累及肱骨，74%累及前臂。在肱骨骨折中，61%的单一远端骨折累及干骺端，在前臂骨折中，80%的单一远端骨折累及干骺端。在青少年中，单一肱骨骨折更常为骨骺骨折和骨干骨折，在青少年中，桡骨骨折比其他年龄组更常为骨骺骨折。47%的合并前臂骨折为远端干骺端骨折。只有0.7%的骨折不能归类于特定儿童骨折类型中的一种。在单一骨骺骨折中，49%为Salter-Harris II型（SH II）骨折；其中，94%发生在学龄儿童和青少年中。在干骺端骨折中，58%表现为不完全骨折类型。89%的不完全骨折累及远端桡骨。在骨干骨折中，32%为青枝骨折。24例孟氏骨折发生在学龄前儿童和学龄儿童中，2例发生在青少年中。解读——根据PCCF可以全面描述儿童上肢骨折的类型。需要进行前瞻性临床研究以确定其对治疗决策和预后判断的临床相关性。
