Kuba Megan H M, Izuka Byron H
Division of Orthopaedic Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu.
Children's Orthopaedics of Hawaii, Mary Savio Medical Plaza, Aiea, HI.
J Pediatr Orthop. 2018 Jul;38(6):e338-e342. doi: 10.1097/BPO.0000000000001169.
Previous studies have showed the efficacy of removable brace treatment for distal radius buckle fractures in children, whereas others have independently suggested that these injuries do not require additional radiographic imaging. However, no study has sought to collectively determine whether treating pediatric distal radius buckle fractures with a removable brace and no follow-up visit or imaging after the initial visit is a safe and satisfactory protocol.
In total, 42 consecutive patients with a distal forearm buckle fracture seen by a single fellowship trained pediatric orthopaedic surgeon were eligible to participate. Two patients refused participation, yielding 40 patients treated with a standard protocol of immobilization with a removable wrist brace for a prescribed period of time with no additional imaging or clinical follow-up. Two staggered telephone surveys were then conducted. The first survey was conducted within 1 week of the designated brace-removal date to determine the exact date the brace was discontinued. The second survey was conducted 5 to10 months postinjury to determine patient outcomes and parent satisfaction.
In total, 100% of patients were reached for the initial survey and 90% (36/40) of patients were reached for the secondary survey. There were no complications, including refracture or residual pain, following treatment. In total, 100% of parents felt their child had returned to full and normal function and all said they would choose to have the same treatment again. In total, 67% of parents would have had to take time off from work and 77% of children would have missed school if they had hypothetically been required to attend a follow-up appointment.
Treatment of pediatric distal forearm buckle fractures with a removable wrist brace and no follow-up visit or radiographs results in both excellent patient outcomes and parental satisfaction.
Level IV-case series.
既往研究已表明可摘式支具治疗儿童桡骨远端青枝骨折的有效性，而其他研究则独立指出这些损伤无需额外的影像学检查。然而，尚无研究试图综合判定，采用可摘式支具治疗儿童桡骨远端青枝骨折且初诊后不进行随访或影像学检查是否为一种安全且令人满意的方案。
共有42例连续的前臂远端青枝骨折患儿由一名接受过专科培训的小儿骨科医生诊治，符合纳入标准。2例患儿拒绝参与，最终40例患儿接受了标准治疗方案，即使用可摘式腕部支具固定规定时间，无需额外的影像学检查或临床随访。随后进行了两次错开时间的电话调查。第一次调查在指定的支具拆除日期后1周内进行，以确定支具实际拆除的日期。第二次调查在受伤后5至10个月进行，以确定患者的治疗结果及家长满意度。
初次调查成功联系到了所有100%的患者，二次调查成功联系到了其中90%（36/40）的患者。治疗后无并发症发生，包括再骨折或残留疼痛。总体而言，100%的家长认为其孩子已恢复至完全正常的功能，且均表示会再次选择相同的治疗方法。总体而言，如果假设需要患儿复诊，67%的家长会不得不请假，77%的患儿会缺课。
采用可摘式腕部支具治疗儿童前臂远端青枝骨折，且不进行随访或拍摄X线片，可取得极佳的患者治疗结果及家长满意度。
IV级——病例系列。
