University of Texas Southwestern Medical School.
The University of Chicago Medicine, Chicago, IL.
J Pediatr Orthop. 2021 Jan;41(1):17-22. doi: 10.1097/BPO.0000000000001699.
The purpose of this study is to examine pediatric patients with a radial neck fracture and determine the factors associated with a failed closed reduction (CR) in the emergency department (ED).
A total of 70 patients with acute radial neck fractures were retrospectively reviewed. Inclusion criteria were: age 18 years or younger at time of injury, diagnosis of radial neck fracture without other associated elbow fractures, an attempt at CR with manipulation in the ED or immediate surgery, open proximal radial physis, and appropriate imaging to categorize the injury. Charts were reviewed and demographic data was obtained. Initial injury films were reviewed and the Judet classification was used to define fracture types/categories.
CR was attempted on 41 patients. Twenty-nine patients went straight to surgery without a CR attempt. Compared with patients that had an attempted CR in the ED, patients that went straight to surgery had longer mean time from injury to ED presentation (5.6 d; P=0.0001), greater mean fracture angulation (55.0 degrees; P=0.001), and greater fracture translation (46.2%; P=0.001). When analyzing the patients that had a CR attempted in the ED, univariate statistical analysis demonstrated that ≥Judet 4 classification (P=0.03), greater amounts of fracture angulation (P=0.003), and a treatment delayed >24 hours from injury (P=0.007) were significant risk factors for failure of CR in the ED. Zero (0/10) patients with fracture angulation ≥60 degrees had a successful CR. Only 1/14 patients presenting >24 hours after injury had a successful CR in the ED.
Circumventing sedation in the ED, and instead splinting for a planned surgical intervention may be a more efficient treatment method for pediatric radial neck fractures that present to the ED>24 hours after injury and/or have angulations ≥60 degrees. Adopting this new strategy may save time, reduce costs, and avoid possible harm/complications associated with sedation in the ED.
Level III-prognostic.
本研究旨在探讨儿童桡骨颈骨折患者，并确定与急诊（ED）闭合复位（CR）失败相关的因素。
回顾性分析 70 例急性桡骨颈骨折患者。纳入标准为：受伤时年龄 18 岁以下，无其他肘部骨折，ED 行手法 CR 或直接手术，开放性近侧桡骨干骺端，且适当影像学检查分类损伤。查阅病历并获取人口统计学数据。回顾初始损伤片，采用 Judet 分类法定义骨折类型/类别。
41 例患者行 CR。29 例患者直接手术，未行 CR。与 ED 行 CR 的患者相比，直接手术的患者从受伤到 ED 就诊的平均时间更长（5.6d；P=0.0001），平均骨折成角更大（55.0°；P=0.001），骨折平移更多（46.2%；P=0.001）。分析 ED 行 CR 的患者，单变量统计分析显示，≥Judet 4 型（P=0.03）、更大的骨折成角（P=0.003）、受伤后治疗延迟＞24 小时（P=0.007）是 ED 行 CR 失败的显著危险因素。骨折成角≥60°的患者中，0（0/10）例 CR 成功。受伤后＞24 小时就诊的患者中，仅 1（1/14）例在 ED 行 CR 成功。
对于 ED 就诊>24 小时且/或成角≥60°的桡骨颈骨折患儿，避免 ED 镇静，而是固定后计划手术干预可能是一种更有效的治疗方法。采用这种新策略可以节省时间，降低成本，并避免 ED 镇静相关的潜在伤害/并发症。
III 级-预后。
