Kubiak Rainer, Aksakal Devrim, Weiss Christel, Wessel Lucas M, Lange Bettina
Department of Pediatric Surgery, Medical Faculty Mannheim (UMM), Heidelberg University.
Department of Medical Statistics and Biomathematics, Mannheim, Germany.
Medicine (Baltimore). 2019 Jul;98(28):e16353. doi: 10.1097/MD.0000000000016353.
To review our institutional results and assess different surgical and non-surgical techniques for the treatment of displaced diametaphyseal forearm fractures in children and adolescents.Thirty-four children (25M, 9F) with a total of 36 diametaphyseal forearm fractures who underwent treatment under general anesthesia between July 2010 and February 2016 were recruited to this retrospective study. From October 2016 until March 2018 patients and/or parents were contacted by telephone and interviewed using a modified Pediatric Outcomes Data Collection Instrument (PODCI).Median age at the time of injury was 9.1 years (range, 1.9-14.6 years). Initial treatment included manipulation under anesthesia (MUA) and application of plaster of Paris (POP) (n = 9), elastic stable intramedullary nailing (ESIN) (n = 10), percutaneous insertion of at least one Kirschner wire (K-wire) (n = 16), and application of external fixation (n = 1). Eleven children (32%) experienced a total of 22 complications. Seven complications were considered as major, including delayed union (n = 1) and extensor pollicis longus (EPL) tendon injury (n = 1) following ESIN, as well as loss of reduction (n = 2) and refractures (n = 3) after MUA/POP. The median follow-up time was 28.8 months (range, 5.3-85.8 months). In 32 out of 34 cases (94%) patients and/or parents were contacted by telephone and a PODCI score was obtained. Patients who experienced complications in the course of treatment had a significantly lower score compared with those whose fracture healed without any sequelae (P = .001). There was a trend towards an unfavorable outcome following ESIN compared with K-wire fixation (P = .063), but not compared with POP (P = .553). No statistical significance was observed between children who were treated initially with a POP and those who had K-wire fixation (P = .216).There is no standard treatment for displaced pediatric diametaphyseal forearm fractures. Management with MUA/POP only is associated with an increased refracture rate. Based on our experience K-wire fixation including intramedullar positioning of at least one pin seems to be favorable compared with ESIN.
回顾我们机构的治疗结果，并评估治疗儿童和青少年肱骨干骺端移位性前臂骨折的不同手术和非手术技术。选取2010年7月至2016年2月期间在全身麻醉下接受治疗的34例儿童（25例男性，9例女性），共36处肱骨干骺端前臂骨折，纳入本回顾性研究。2016年10月至2018年3月，通过电话联系患者和/或家长，并使用改良的儿童结果数据收集工具（PODCI）进行访谈。受伤时的中位年龄为9.1岁（范围1.9 - 14.6岁）。初始治疗包括麻醉下手法复位（MUA）并应用巴黎石膏（POP）（n = 9）、弹性稳定髓内钉固定（ESIN）（n = 10）、经皮插入至少一根克氏针（K针）（n = 16）以及应用外固定（n = 1）。11名儿童（32%）共经历了22种并发症。7种并发症被视为严重并发症，包括ESIN术后骨延迟愈合（n = 1）和拇长伸肌（EPL）肌腱损伤（n = 1），以及MUA/POP术后复位丢失（n = 2）和再骨折（n = 3）。中位随访时间为28.8个月（范围5.3 - 85.8个月）。34例中的32例（94%）通过电话联系了患者和/或家长，并获得了PODCI评分。治疗过程中出现并发症的患者与骨折愈合且无任何后遗症的患者相比，评分显著更低（P = 0.001）。与K针固定相比，ESIN术后有预后不良的趋势（P = 0.063），但与POP相比无此趋势（P = 0.553）。最初接受POP治疗的儿童与接受K针固定的儿童之间未观察到统计学差异（P = 0.216）。对于儿童肱骨干骺端移位性前臂骨折，尚无标准治疗方法。仅采用MUA/POP治疗会增加再骨折率。根据我们的经验，与ESIN相比，包括至少一根针髓内定位的K针固定似乎更具优势。
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