University of Minnesota Medical School.
Gillette Children's Specialty Healthcare, St. Paul, MN.
J Pediatr Orthop. 2021;41(5):267-272. doi: 10.1097/BPO.0000000000001787.
One of the most common pediatric fractures is a midshaft both bone forearm fracture. The preferred nonoperative treatment is cast immobilization for 6 to 8 weeks; however, 4% to 8% refracture within 6 months. There are no comparative studies evaluating the efficacy of bracing after cast immobilization. We hypothesized that children treated with prolonged functional bracing would have a lower rate of refracture than casting alone or short-term bracing.
This is a retrospective review of children younger than 15 years of age treated nonoperatively following radius and ulnar shaft fractures treated at 3 tertiary pediatric hospitals. We excluded distal radius/ulna fractures, isolated fractures of the radius/ulna, and fractures near the elbow. Logistic regression analysis on casting plus functional bracing was run to determine if age, translation, or the number of days in brace were associated with refracture. The incidence of refracture was compared between groups.
A total of 1549 patients were screened and 426 were included in the study [111 casting only (CO), 259 casting plus functional brace <8 wk (CFB <8 wk), 56 casting plus functional brace ≥8 wk (CFB ≥8 wk)]. In comparing the groups, CO was the youngest (4.4 y vs. 6.3 and 8.4 y). The initial translation and angulation of the radius and ulna were significantly greater in the CFB ≥8 weeks group. Regression analyses shows no association between refracture and initial fracture characteristics including age, translation, or the number of days in brace. The CO group had 3 refractures (2.7%), the CFB <8 weeks group had 13 (5%) and the CFB ≥8 weeks group had 1 (1.8%); demonstrating no statistical significance.
Extended fracture bracing, following a period of cast immobilization, did not lead to a statistically significant difference in refracture rate. Contrary to previous cases series, the benefit of bracing seems nominal. Larger, prospective studies are needed to better understand targets for treatment.
This is the first level III retrospective comparison study of its kind.
儿童中最常见的骨折之一是尺桡骨干双骨折。首选的非手术治疗是石膏固定 6 至 8 周；然而，4%至 8%的患者在 6 个月内再次骨折。目前尚无比较研究评估石膏固定后支具治疗的效果。我们假设，与单纯石膏固定或短期支具固定相比，接受长时间功能支具治疗的儿童再次骨折的发生率更低。
这是对 3 家三级儿童医院接受非手术治疗的尺桡骨干骨折患儿的回顾性研究。我们排除了桡骨远端/尺骨骨折、单纯桡骨/尺骨骨折和靠近肘部的骨折。对石膏固定加功能支具的患者进行逻辑回归分析，以确定年龄、移位或支具使用天数是否与再骨折有关。比较各组的再骨折发生率。
共筛选了 1549 例患者，其中 426 例纳入研究[111 例单纯石膏固定（CO）、259 例石膏固定加功能支具<8 周（CFB <8 周）、56 例石膏固定加功能支具≥8 周（CFB ≥8 周）]。在比较各组时，CO 组年龄最小（4.4 岁比 6.3 岁和 8.4 岁）。CFB ≥8 周组的桡骨和尺骨初始移位和成角明显更大。回归分析显示，再骨折与初始骨折特征（包括年龄、移位或支具使用天数）之间无关联。CO 组有 3 例（2.7%）、CFB <8 周组有 13 例（5%）、CFB ≥8 周组有 1 例（1.8%），差异无统计学意义。
在石膏固定一段时间后，延长骨折支具固定并没有导致再骨折率的统计学显著差异。与之前的病例系列研究相反，支具治疗的益处似乎微不足道。需要更大规模的前瞻性研究来更好地了解治疗目标。
这是第一项同类的三级回顾性比较研究。
