Dua Karan, Hosseinzadeh Pooya, Baldwin Keith D, Abzug Joshua M
Instr Course Lect. 2019;68:395-406.
Pediatric and adolescent forearm fractures account for nearly 40% of all fractures in childhood. The incidence of these fractures has increased over the past decade with a 10-fold increase in surgical intervention. A thorough physical examination of the upper extremity, with plain radiographs of the forearm, should be obtained to make the diagnosis. The primary modality of management for closed both-bone forearm fractures is a closed reduction if needed and long arm immobilization. Patients should be followed up weekly, for at least 3 weeks, to ensure maintenance of fracture alignment. Failure of closed management is a known complication of nonsurgical management, and providers should have a management algorithm to treat these patients. Re-manipulation and casting, or cast wedging, is warranted if the loss of reduction is noted early in the postreduction period. If closed reduction cannot be achieved, elastic stable intramedullary nailing is the management of choice with either single- or both-bone fixation. Potential complications of elastic stable intramedullary nailing include acute compartment syndrome, nonunion, dorsal radial sensory nerve neuritis, and extensor pollicis longus tendon rupture. In older children and adolescents with less remodeling potential, osteosynthesis with plate-and-screw fixation or hybrid fixation should be used.
小儿和青少年前臂骨折占儿童期所有骨折的近40%。在过去十年中，这些骨折的发生率有所上升，手术干预增加了10倍。应进行上肢的全面体格检查，并拍摄前臂平片以做出诊断。闭合性双骨前臂骨折的主要治疗方式是必要时进行闭合复位和长臂固定。患者应每周随访，至少随访3周，以确保骨折对线的维持。闭合治疗失败是保守治疗的已知并发症，医疗人员应有治疗这些患者的管理方案。如果在复位后早期发现复位丢失，则需要重新手法复位和石膏固定，或楔形石膏固定。如果无法实现闭合复位，弹性稳定髓内钉固定是单骨或双骨固定的首选治疗方法。弹性稳定髓内钉固定的潜在并发症包括急性骨筋膜室综合征、骨不连、桡背侧感觉神经神经炎和拇长伸肌腱断裂。对于重塑潜力较小的大龄儿童和青少年，应采用钢板螺钉固定或混合固定进行骨合成。
