Department of Paediatrics, The University of Melbourne, Australia.
Emergency Department, Royal Children's Hospital, Melbourne, Australia.
Am J Emerg Med. 2021 Dec;50:59-65. doi: 10.1016/j.ajem.2021.06.073. Epub 2021 Jul 2.
Forearm fractures are common pediatric injuries. Most displaced or angulated fractures can be managed via closed reduction in the operating room or in the Emergency Department (ED). Previous research has shown that emergency physicians can successfully perform closed reduction within ED; however, the fracture morphology amendable to ED physician reduction is unclear. The aim of this study is to detail the fracture characteristics associated with successful reduction by ED physicians.
We conducted a retrospective study of children (aged <18 years) presenting to the ED of a tertiary care children's hospital (annual census 90,000) between January 2018 and December 2018 with closed distal and midshaft forearm fractures requiring reduction. Data collected included patient demographics, fracture morphology, management, and complications. Successful ED physician reduction was based on predefined criteria. Orthopedic referrals included those patients sent directly to the operating room, closed reductions performed by orthopedic trainees within the ED, and patients requiring orthopedic consultation after failed ED reduction.
A total of 340 patients with forearm fractures were included in the study. ED clinicians attempted to reduce 274 (80.6%) of these fractures and were successful in 256/274 (93.4%) cases. Of the 84 orthopedic referrals, 18 were after failed ED clinician attempt, and 66 were ab initio managed by orthopedics (37 in the operating room and 29 in ED). Compared to the fractures with successful ED reduction (n = 256), factors associated with orthopedic referral (n = 84) included: increasing age, midshaft location, higher degree of angulation, and completely displaced fractures. Angulated distal greenstick fractures were most likely to be successfully reduced by ED clinicians. There were no difference in complication rates between the two groups.
In this series, fractures most amenable to reduction by ED clinicians include distal greenstick fractures, whereas midshaft and completely displaced fractures are more likely to need treatment by orthopedics.
前臂骨折是儿童常见的损伤。大多数移位或成角的骨折可以通过手术室或急诊科（ED）的闭合复位来治疗。先前的研究表明，急诊医生可以在 ED 成功进行闭合复位；然而，ED 医生可复位的骨折形态尚不清楚。本研究旨在详细描述与 ED 医生成功复位相关的骨折特征。
我们对 2018 年 1 月至 2018 年 12 月期间在一家三级儿童医院 ED 就诊的（年就诊量 90000 例）患有闭合性远段和中段前臂骨折且需要复位的儿童（年龄<18 岁）进行了回顾性研究。收集的数据包括患者人口统计学、骨折形态、治疗方法和并发症。ED 医生成功复位是基于预设标准。骨科转诊包括直接送到手术室的患者、ED 内的骨科培训医生进行的闭合复位以及 ED 复位失败后需要骨科会诊的患者。
共有 340 例前臂骨折患者纳入本研究。ED 临床医生尝试对 274 例（80.6%）骨折进行复位，其中 256/274（93.4%）例成功。在 84 例骨科转诊中，有 18 例是在 ED 医生复位失败后转诊的，66 例是骨科初始治疗的（37 例在手术室，29 例在 ED）。与 ED 复位成功的骨折（n = 256）相比，需要骨科转诊的因素（n = 84）包括：年龄增加、中段位置、成角程度更高和完全移位的骨折。ED 医生最有可能成功复位成角的远段青枝骨折。两组并发症发生率无差异。
在本系列中，最适合 ED 医生复位的骨折包括远段青枝骨折，而中段和完全移位的骨折更可能需要骨科治疗。
