Bin Kim, Rony Louis, Henric Nicolas, Moukoko Didier
Pediatric Orthopedic Surgery Department, CHU d'Angers, 4, rue Larrey, 49933 Angers, France.
Pediatric Orthopedic Surgery Department, CHU d'Angers, 4, rue Larrey, 49933 Angers, France; Orthopedic Surgery Department, CHU d'Angers, 4, rue Larrey, 49933 Angers, France.
Orthop Traumatol Surg Res. 2022 Feb;108(1S):103155. doi: 10.1016/j.otsr.2021.103155. Epub 2021 Nov 27.
Limb fractures are a large part of pediatric trauma activity. Conservative treatment is possible because of children's bone remodeling potential. In case of displaced fractures, when a closed reduction can be done in the emergency room (ER), this avoids general anesthesia, hospitalization and the associated costs. In well-defined situations, there is a consensus about the indication for fracture reduction in the ER. Some complex fracture cases require immediate treatment in the operating room: intra-articular fractures, pathological fractures, fractures with associated skin, nerve or vascular injuries and/or early signs of compartment syndrome. And last, there is another set of fractures where the indication is not so clear. To specify the indications and technical implementation of these treatments in ER, we did a non-systematic narrative review of literature in the MEDLINE® database using the PubMed search engine to query "emergency room AND children AND fracture AND reduction". We retained the most recent articles addressing the questions related to indications and their care, sedation protocol and complications. The sedation protocol for the ER is established collaboratively by surgical, ER and anesthesia teams. The residual angulation that can be tolerated after reduction depends on the patient's age, remaining growth potential and location of the fracture line. When reduction is done in the ER, the complication and secondary displacement rates are not higher, although surgeon experience and specific procedural training appear to be crucial.
四肢骨折是儿童创伤活动的重要组成部分。由于儿童骨骼具有重塑潜力，保守治疗是可行的。对于移位骨折，若能在急诊室进行闭合复位，则可避免全身麻醉、住院及相关费用。在明确的情况下，对于急诊室骨折复位的适应证已达成共识。一些复杂骨折病例需要在手术室立即治疗：关节内骨折、病理性骨折、伴有皮肤、神经或血管损伤的骨折和/或骨筋膜室综合征的早期迹象。最后，还有一组骨折的适应证并不那么明确。为了明确这些急诊治疗的适应证和技术实施方法，我们使用PubMed搜索引擎在MEDLINE®数据库中对文献进行了非系统性叙述性综述，检索词为“急诊室 AND 儿童 AND 骨折 AND 复位”。我们保留了涉及适应证及其治疗、镇静方案和并发症相关问题的最新文章。急诊室的镇静方案由外科、急诊室和麻醉团队共同制定。复位后可耐受的残余成角取决于患者年龄、剩余生长潜力和骨折线位置。在急诊室进行复位时，尽管外科医生的经验和特定的操作培训似乎至关重要，但并发症和二次移位率并不更高。
