Herman Martin J, Ashok Annie P, Williams Christine S
Instr Course Lect. 2019;68:383-394.
Diaphyseal fractures of the radius and ulna are common injuries in children and often result from a fall on an outstretched hand. Fractures are classified by completeness, angular and rotational deformity, and displacement. The goal of management is to correct the deformity to the anatomic position or within acceptable alignment parameters as defined in the literature. This is primarily achieved by closed reduction and immobilization. Greenstick fractures are reduced by rotation of the palm toward the apex of the deformity. Complete fractures are reduced with sustained traction and manipulation. All fractures are immobilized in a cast, applied with the proper molding technique to ensure adequate stabilization, and maintained until healing is evident. Follow-up radiographs should be obtained weekly during the first 3 weeks after reduction to assess loss of reduction. Generally, postreduction malalignment greater than 20° is unacceptable, but these parameters vary based on age, fracture pattern, and the location and plane of angulation. Surgical intervention, with intramedullary nailing or plate fixation, is indicated for open fractures, for those with substantial soft-tissue injury, and when acceptable alignment cannot be achieved or maintained. Successful outcomes are seen in most forearm fractures in children, based on bone healing and restoration of functional forearm range of motion.
桡骨和尺骨干骨折是儿童常见的损伤，通常由伸手撑地摔倒所致。骨折根据完整性、成角和旋转畸形以及移位进行分类。治疗的目标是将畸形矫正至解剖位置或达到文献中定义的可接受的对线参数范围内。这主要通过闭合复位和固定来实现。青枝骨折通过将手掌向畸形顶点旋转来复位。完全骨折通过持续牵引和手法复位。所有骨折均用石膏固定，采用适当的塑形技术以确保充分稳定，并维持至愈合明显。复位后的前3周应每周拍摄随访X线片以评估复位丢失情况。一般来说，复位后成角畸形大于20°是不可接受的，但这些参数会因年龄、骨折类型以及成角的位置和平面而有所不同。对于开放性骨折、伴有严重软组织损伤的骨折以及无法实现或维持可接受对线的情况，需进行手术干预，采用髓内钉或钢板固定。基于骨折愈合和前臂功能活动范围的恢复，大多数儿童前臂骨折都能取得成功的治疗结果。
