Ploegmakers Joris J W, Groen Wilhelmina M G A C, Haverlag Robert, Bulstra Sjoerd K
Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Orthopaedics, University Medical Center Utrecht, the Netherlands.
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):269-274. doi: 10.1016/j.jcot.2019.04.022. Epub 2019 May 2.
Alignment loss after reduction and cast immobilisation of angulated and/or complete displaced forearm fractures is challenging. Many authors have tried to describe risk factors and create indices (initial angulation, initial complete displacement, lack of anatomic reduction, cast and padding index) in order to identify those fractures that are prone to losing their alignment during treatment.
This retrospective case-control study included children sustaining both-bone forearm fractures treated by closed reduction and cast immobilisation. Basic characteristics were recorded and radiographs evaluated to measure displacement and angulation before and after reduction, cast index and padding index. The primary outcome was loss of reduction during the immobilisation period.
Group A consisted of 22 patients in whom >5° reduction loss was seen during cast immobilisation. Group B consisted of 16 patients with <5° reduction loss. After multivariate analyses we found group A included more broken cortices, with a statistically significant higher number of initial displaced fractures (p < 0.001 and p = 0.010) and residual displacement (p = 0.022). The cast and padding index did not differ significantly between groups (p = 0.77 and 0.15 respectively).
Cast and padding index did not correlate well as predictor of alignment loss, although in this study cortical stability seemed more important towards predicting alignment loss.
对于成角和/或完全移位的前臂骨折，复位后采用石膏固定时出现对线丢失是一项具有挑战性的问题。许多作者试图描述风险因素并创建指数（初始成角、初始完全移位、解剖复位不佳、石膏和衬垫指数），以便识别那些在治疗过程中容易出现对线丢失的骨折。
这项回顾性病例对照研究纳入了接受闭合复位和石膏固定治疗的儿童双骨干前臂骨折患者。记录基本特征，并对X线片进行评估，以测量复位前后的移位和成角情况、石膏指数和衬垫指数。主要结局是固定期间复位丢失。
A组由22例患者组成，这些患者在石膏固定期间出现了>5°的复位丢失。B组由16例复位丢失<5°的患者组成。多因素分析后，我们发现A组有更多的皮质骨折，初始移位骨折数量（p < 0.001和p = 0.010）和残余移位（p = 0.022）在统计学上显著更高。两组之间的石膏和衬垫指数无显著差异（分别为p = 0.77和0.15）。
石膏和衬垫指数作为对线丢失的预测指标相关性不佳，尽管在本研究中皮质稳定性似乎对预测对线丢失更为重要。
