Maggio Albane B R, Martin Xavier, Tabard-Fougère Anne, Steiger Christina, Dayer Romain, Delhumeau Cécile, Ceroni Dimitri
Pediatric Cardiology Unit, Department of Child and Adolescent, Division of Pediatric Specialties.
Service of Pediatric Orthopedics, Department of Child and Adolescent.
J Pediatr Orthop. 2019 Apr;39(4):e248-e252. doi: 10.1097/BPO.0000000000001300.
Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up.
We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients.
At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group's ultradistal radius and whole wrists (+4.8% to +5.2%).
A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.
腕部和前臂骨折后，石膏固定导致的骨矿物质流失和肌肉萎缩是可预见的后果。本研究旨在前瞻性地确定先前报道的儿童和青少年腕部及前臂骨折固定后较低的骨矿物质含量在6个月和18个月随访时是否已恢复。
我们招募了50名因前臂或腕部骨折接受石膏固定的儿童和青少年。在骨折时、拆除石膏时、6个月和18个月随访时对不同骨骼部位进行双能X线吸收测定扫描。受伤患者根据性别和年龄与健康对照配对。比较各组之间以及患者受伤和未受伤前臂的双能X线吸收测定值。
骨折时，受伤组和健康组在腰椎的骨密度（BMD）和骨矿物质含量（BMC）z评分之间，以及外周腕部的BMD之间均无差异。拆除石膏时，受伤组上肢骨矿物质变量（除桡骨远端最末端外）显著低于未受伤组，差异范围为3.8%至10.2%。在6个月和18个月随访时（28名受伤患者），上肢任何部位均未观察到骨矿物质变量的残留下降。受伤组桡骨远端最末端和整个腕部的BMD和BMC有显著的残留增加（+4.8%至+5.2%）。
通过恢复活动，骨量迅速逆转，前臂或腕部骨折6个月后骨完全恢复。最后，愈合的骨痂可能会对骨折部位BMD和BMC数据的解释产生偏差，不仅在拆除石膏时，而且在骨折后18个月时也是如此。
