Clinic of Adult and Paediatric Orthopaedics, Ospedali Riuniti, Ancona, Italy.
Department of Orthopedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy.
Acta Biomed. 2021 Nov 3;92(5):e2021390. doi: 10.23750/abm.v92i5.11971.
Children displaced distal radius fractures (DRFs) are commonly treated by reduction. Yet, their excellent remodeling ability provides good clinical-radiographic outcomes even in case of non-anatomical reduction. The reduction under analgesia or sedation involves hospitalizations, greater risks, and higher hospital costs. The aim of this preliminary study is to demonstrate the accountability and conveniency of non-anatomical reduction.
The study involved all 0-8 years-old children who were affected by a closed overriding DRF from February 2017 to December 2018 and were managed non-operatively by a long arm cast without reduction, analgesia, or sedation treatments. We retrospectively evaluated their clinical-radiographic outcomes and healing time. The costs of no-reduction treatments were compared with those of the two main approaches to DRFs, that is: closed reduction under sedation and application of a long arm cast; closed reduction under anesthesia, percutaneous pinning, and application of a long arm cast. The comparison was based on the Diagnosis Related Group system.
We treated 11 children with an average initial radial shortening of 5±3 mm and average initial sagittal and coronal angulations of 4.0° and 3.5°, respectively. Average casting duration was 40 days. All patients achieved a full range of wrist motion without deformities. The procedure was respectively 7 times less expensive than closed reduction in emergency room under sedation and application of a long arm cast, and 64 times less expensive than closed reduction in the operating room under anesthesia, percutaneous pinning, and application of a long arm cast.
In children aged 0-8 years, non-operative treatment of closed overriding DRFs with a long arm cast without reduction is a simple and cost-effective procedure with both clinical and radiographic medium-term excellent outcomes.
儿童桡骨远端骨折（DRF）通常采用复位治疗。然而，儿童骨骼具有极好的重塑能力，即使复位不理想，也能获得良好的临床和影像学结果。在麻醉或镇静下进行复位需要住院治疗，存在更大的风险和更高的住院费用。本初步研究旨在证明非解剖复位的可行性和便利性。
本研究纳入了 2017 年 2 月至 2018 年 12 月期间因闭合性桡骨远端重叠性骨折就诊的 0-8 岁儿童，采用长臂石膏固定非手术治疗，未进行复位、镇痛或镇静治疗。我们回顾性评估了其临床和影像学结果及愈合时间。将非复位治疗的费用与 DRF 的两种主要治疗方法（镇静下闭合复位+长臂石膏固定、全身麻醉下闭合复位+经皮克氏针固定+长臂石膏固定）进行比较，比较依据为疾病诊断相关分组系统。
我们共治疗了 11 例患儿，平均初始桡骨缩短 5±3mm，矢状面和冠状面成角分别为 4.0°和 3.5°。平均固定时间为 40 天。所有患者均获得了完全的腕关节活动范围，无畸形。与镇静下急诊室闭合复位+长臂石膏固定相比，该方法的费用分别降低了 7 倍，与全身麻醉下复位+经皮克氏针固定+长臂石膏固定相比，费用降低了 64 倍。
对于 0-8 岁儿童，采用长臂石膏固定治疗闭合性桡骨远端重叠性骨折，不进行复位，是一种简单、经济有效的方法，具有良好的临床和影像学中期结果。
