Wolf M, Da Fonseca K
Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Klinik für Orthopädie und Unfallchirurgie, Sektion Obere Extremität, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
Orthopade. 2019 Jun;48(6):531-535. doi: 10.1007/s00132-019-03741-6.
Fractures of the distal forearm are common in children. While we treat adults by trying to anatomically reconstruct the wrist joint, in children, fracture treatment is predominantly conservative due to the high correction potential of the distal growth plate. However, the presentation of young adults with post-traumatic wrist pain is not unusual.
Do pediatric distal forearm fractures really heal without consequences despite a large tolerance of axial deviation?
Review of the literature, discussion of results and case report.
Positive ulnar variance is the most common sequelae of pediatric distal forearm fractures. A positive variance of as little as >2 mm frequently causes ulnar-sided wrist pain and loss of motion, as is also shown in our case.
Careful follow-up is advisable beyond fracture union following pediatric distal forearm fractures, especially after transphyseal osteosynthesis or growth plate involvement. Reconstructively corrective osteotomy of the ulna should be considered in patients with corresponding clinical symptoms, radiological findings and a positive ulnar variance of >2 mm.
儿童前臂远端骨折很常见。在治疗成人时,我们试图通过解剖重建腕关节来进行治疗,但在儿童中,由于远端生长板具有较高的矫正潜力,骨折治疗主要是保守治疗。然而,年轻成人出现创伤后腕部疼痛的情况并不少见。
尽管对轴向偏差有较大耐受性,但小儿前臂远端骨折真的能毫无后果地愈合吗?
文献回顾、结果讨论及病例报告。
尺骨正向变异是小儿前臂远端骨折最常见的后遗症。在我们的病例中也显示,仅>2毫米的正向变异就经常导致尺侧腕部疼痛和活动受限。
小儿前臂远端骨折愈合后,尤其是在经骨骺接骨术或生长板受累后,建议进行仔细的随访。对于有相应临床症状、影像学表现且尺骨正向变异>2毫米的患者,应考虑进行尺骨重建性截骨术。