Constantino Diogo M C, Machado Luis, Carvalho Marcos, Cabral João, Sá Cardoso Pedro, Balacó Inês, Ling Tah Pu, Alves Cristina
Department of Pediatric Orthopaedics, Hospital Pediátrico de -Coimbra, Coimbra, Portugal.
J Child Orthop. 2021 Dec 1;15(6):532-539. doi: 10.1302/1863-2548.15.210111.
Distal radius fractures represent one of the most common fractures in children. Our purpose is to analyze risk factors for redisplacement in children with distal radius fractures treated by means of closed reduction and plaster cast immobilization.
Retrospective study, including children under the age of 17 years, who underwent closed manipulation and cast immobilization for a distal third radius fracture, between 2012 and 2015. Preoperative radiographs were reviewed for initial translation, angulation and shortening, distance of the fracture from the physis, degree of fracture obliquity and the presence of an ulna fracture. Postoperative radiographs were analyzed for translation, angulation and shortening, as well as the quality of closed reduction. Cast index, gap index and three-point index, were measured on the postoperative radiographs. Redisplacement and re-intervention during follow-up were registered.
A total of 26 patients were included in this study. Comparison between post-reduction and immediate post-cast removal radiographs did not show any statistically significant difference between translation or shortening. Coronal (p = 0.002) and sagittal (p = 0.002) angulation showed a statistically significant difference, but both median values remained below cut-off values for redisplacement. Redisplacement was observed in four patients. Only one patient underwent remanipulation. All four had full remodelling and proper radiological alignment at final follow-up. Quality of reduction was found to be a statistically significant risk factor for redisplacement (p = 0.013).
Closed reduction and cast immobilization under general anaesthesia yields good results in the treatment of distal forearm fractures in paediatric patients. Quality of reduction was the only risk factor that we found to be predictive of redisplacement.
Level III - Retrospective comparative study.
桡骨远端骨折是儿童最常见的骨折之一。我们的目的是分析采用闭合复位及石膏固定治疗的儿童桡骨远端骨折再移位的危险因素。
回顾性研究，纳入2012年至2015年间接受闭合手法复位及石膏固定治疗桡骨远端三分之一骨折的17岁以下儿童。术前X线片用于评估初始的移位、成角和缩短情况、骨折距骨骺的距离、骨折倾斜度以及尺骨骨折的存在情况。术后X线片用于分析移位、成角和缩短情况以及闭合复位的质量。在术后X线片上测量石膏指数、间隙指数和三点指数。记录随访期间的再移位和再次干预情况。
本研究共纳入26例患者。复位后与拆除石膏后即刻的X线片比较显示，在移位或缩短方面无统计学显著差异。冠状面（p = 0.002）和矢状面（p = 0.002）成角有统计学显著差异，但两个中位数均低于再移位的临界值。4例患者出现再移位。仅1例患者接受了再次手法复位。所有4例在最终随访时均完全重塑且放射学对线良好。发现复位质量是再移位的统计学显著危险因素（p = 0.013）。
全身麻醉下的闭合复位及石膏固定在小儿患者前臂远端骨折治疗中效果良好。我们发现复位质量是唯一可预测再移位的危险因素。
Ⅲ级——回顾性比较研究。
