Marson Ben A, Ng Jimmy W G, Craxford Simon, Chell Julian, Lawniczak Dominik, Price Kathryn R, Ollivere Ben J, Hunter James B
Department of Orthopaedics, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust Queens' Medical Centre, Nottingham, UK.
Division of Rheumatology, Orthopaedics & Sports Medicine, Dermatology, University of Nottingham, Queens Medical Centre, Nottingham, UK.
Bone Joint J. 2021 May;103-B(5):902-907. doi: 10.1302/0301-620X.103B.BJJ-2020-1740.R1. Epub 2021 Mar 12.
The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining.
A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires.
Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections.
Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: 2021;103-B(5):902-907.
儿童桡骨远端完全移位骨折的治疗仍存在争议。本研究评估了对仍有至少两年潜在生长时间的儿童“末端”骨折进行手术和非手术治疗的结果。
2015年11月1日至2020年1月1日期间，共有34名男孩和22名女孩，年龄在0至10岁，患有闭合性、完全移位的桡骨远端干骺端骨折。2018年后，10岁及以下儿童接受了伸直位石膏固定治疗或在麻醉下手法复位并用克氏针固定。回顾病例记录和X线片以评估治疗结果。其中，16例接受了伸直位石膏固定治疗，40例接受了麻醉下手法复位，包括37例用克氏针固定。
接受伸直位石膏固定治疗的儿童，均获得良好的关节活动度（ROM）出院。5例儿童在6至12周出院，6个月随访时无功能受限。共有11例儿童在12至50周出院，ROM正常，并有影像学重塑证据。1例儿童在初次骨折4年后，在原损伤近端发生骨干骨折。17例接受麻醉下手法复位的儿童出现了大于10°的成角再移位。4例出院时可见外观畸形，9例存在活动受限，其中4例需要物理治疗。1例儿童针道处出现过度肉芽组织，1根克氏针埋入，导致在门诊取出困难。无儿童发生针道感染。
在适当选择的病例中，对桡骨远端完全移位骨折进行非手术治疗可取得良好效果，且不会使儿童面临手术风险。本研究表明，对这些损伤进行非手术治疗是一种可行且可能未得到充分利用的策略。引用本文：2021;103-B(5):902-907。
