Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Eur J Trauma Emerg Surg. 2019 Dec;45(6):1003-1011. doi: 10.1007/s00068-018-1011-y. Epub 2018 Oct 1.
Displaced distal radius fractures in children are common and often treated by reduction and cast immobilization. Redisplacement occurs frequently and may be prevented by additional treatment with K-wire fixation after initial reduction. This meta-analysis aims to summarize available literature on this topic and determine if primary K-wire fixation is the preferred treatment for displaced distal radius fractures in children.
A search in eight databases identified studies that compared cast immobilization alone to additional K-wire fixation as treatment for displaced paediatric distal radius fractures. The primary outcome was the redisplacement rate. Secondary outcomes were secondary reduction rate, range of motion and complications. This meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.
Three RCTs and 3 cohort studies, analysing 197 patients treated with cast immobilization alone and 185 with additional K-wire fixation, were included in this meta-analysis. Redisplacement occurred less frequently after additional K-wire fixation than after cast alone (3.8 versus 45.7%; OR 0.07, 95% CI 0.03-0.15). Secondary reduction was performed in 59.8% of the redisplaced fractures. Complications, other than redisplacement, occurred more often after additional K-wire fixation than after cast alone (15.7 versus 3.6%). Range of motion did not differ after both treatments.
Additional K-wire fixation is a suitable treatment to prevent redisplacement and secondary operations after initial reduction of displaced distal radius fractures in children, but is associated with post-procedural complications. Additional K-wire fixation does not result in a better range of motion than cast immobilization alone. More research is needed to identify those patients who will benefit the most from K-wire fixation as a treatment for displaced distal radius fractures in children.
儿童桡骨远端骨折较为常见，通常采用复位和石膏固定治疗。复位后容易再次移位，初次复位后采用克氏针固定可预防再移位。本荟萃分析旨在总结该主题的现有文献，并确定克氏针固定是否是儿童桡骨远端骨折的首选治疗方法。
在八个数据库中进行搜索，以确定比较单独石膏固定与附加克氏针固定治疗儿童桡骨远端移位骨折的研究。主要结局是再移位率。次要结局是二次复位率、活动范围和并发症。本荟萃分析根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。
纳入了 3 项 RCT 和 3 项队列研究，共分析了 197 例单独石膏固定治疗和 185 例附加克氏针固定治疗的患者。附加克氏针固定后再移位的发生率低于单独石膏固定（3.8%比 45.7%；OR 0.07，95%CI 0.03-0.15）。59.8%的再移位骨折需要进行二次复位。除再移位外，附加克氏针固定后并发症的发生率高于单独石膏固定（15.7%比 3.6%）。两种治疗方法的活动范围无差异。
附加克氏针固定是预防儿童桡骨远端骨折初次复位后再移位和二次手术的一种合适治疗方法，但与术后并发症有关。附加克氏针固定并不能比单独石膏固定获得更好的活动范围。需要进一步研究以确定哪些患者最受益于克氏针固定作为儿童桡骨远端骨折的治疗方法。
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