Yeo Je Hyoung, Jung Sung Taek, Kim Min Cheol, Yang Hong Yeol
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.
J Orthop Trauma. 2018 Feb;32(2):e52-e58. doi: 10.1097/BOT.0000000000001029.
To delineate the contributing factors of diaphyseal fracture nonunion in children and to determine suggested treatment based on the cohort examined.
Retrospective review.
16 children who underwent operative treatment for diaphyseal nonunion from January 1995 to December 2009.
Stabilization by internal or external fixators with or without bone grafting.
Clinical reviews were evaluated by the side of the injury, mechanism of injury, time interval between injury and surgery, operation time, initial treatment type, and nonunion treatment type, and demographic date including age, sex, the presence or absence of pediatric diabetes, and follow-up duration. Radiographic evaluations were obtained to confirm the fracture site and the classification of the fracture pattern preoperatively, and they were used to postoperatively detect the type of nonunion, the time interval between the treatment of nonunion to bony union, and the residual deformity.
The youngest patient was 6 years with the average age being 11.1 years. Only one of the patients was younger than 8 years, so the distribution was a closed interval beginning at this age. Regardless of age, 16 of the patients were likely to experience nonunion if high-energy traumas and iatrogenic soft tissue injuries caused by the open-reduction procedure were abundant at the time of the fractures.
The frequency of occurrence was affected by the age of the patient, and it increased when there was extensive iatrogenic soft tissue or insufficient fixation at the time of fracture. Close attention should be paid when dealing with nonunion so that iatrogenic damage is not caused, and sufficient fixation should be performed with adequate tools. Also, it should be noted that it is not unusual for deformities to occur and correction for such deformities should also be considered at the time of surgery.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
明确儿童骨干骨折不愈合的相关因素，并根据所研究的队列确定建议的治疗方法。
回顾性研究。
1995年1月至2009年12月期间接受骨干骨折不愈合手术治疗的16名儿童。
采用内固定或外固定器固定，可加或不加植骨。
通过损伤侧、损伤机制、损伤与手术之间的时间间隔、手术时间、初始治疗类型和骨折不愈合治疗类型对临床情况进行评估，以及包括年龄、性别、是否患有儿童糖尿病和随访时间在内的人口统计学数据。术前进行影像学评估以确认骨折部位和骨折类型分类，并在术后用于检测骨折不愈合类型、骨折不愈合治疗至骨愈合的时间间隔以及残留畸形。
最年轻的患者为6岁，平均年龄为11.1岁。只有1名患者年龄小于8岁，因此该年龄为分布的下限。无论年龄大小，如果骨折时高能创伤和切开复位手术导致的医源性软组织损伤较多，16名患者均有可能发生骨折不愈合。
发生率受患者年龄影响，骨折时医源性软组织广泛或固定不充分时发生率增加。处理骨折不愈合时应密切关注，以免造成医源性损伤，并应使用合适的工具进行充分固定。此外，应注意畸形的发生并不罕见，手术时也应考虑对此类畸形进行矫正。
治疗性四级证据。有关证据水平的完整描述，请参阅《作者须知》。
