Department of Anatomical, Histological, Forensic Medicine and Musculoskeletal System Sciences, Sapienza University of Rome, Italy.
IRCCS Bambino Gesù Paediatric Hospital, Rome, Italy.
Clin Ter. 2022 Feb 7;173(1):84-87. doi: 10.7417/CT.2022.2397.
Distal radius fractures represent one of the most fre-quent injuries in children. The treatment of choice is a closed reduction followed by immobilisation in plaster cast; the immediate recourse to osteosynthesis with Kirschner wires is only reserved for certain cases. The displacement rate reported in the literature is 21-39%. The aim of this study is to retrospectively evaluate the risk factors for a secondary displacement of metaphyseal radius fractures in a paediatric population treated in three different centres.
The initial treatment for all 360 patients examined was a closed reduction under general anaesthesia and im-mobilisation in an above elbow cast for 4 weeks. The pre-operative displacement, residual post-reduction displacement and possible di-splacement at 7 and 14 days of follow-up were all assessed clinically and radiographically.
A loss of reduction was reported in 102 cases; 51 under-went an additional reduction procedure - some followed by osteo-synthesis - while in the remaining 51 cases, the loss of reduction was acceptable in relation to the expectation of remodelling. The most statistically significant variable for the occurrence of a secondary displacement is a severe primary displacement. The association with the ulna fracture is not significantly correlated. The quality of the plaster cast is important for maintaining the reduction. There are a few things to consider as indicators for a second procedure: age, time elapsed from moment of fracture, fracture site and the absence of an acceptable reduction.
In our experience, a reduction followed by osteo-synthesis with Kirschner wires should be considered the treatment of choice in fractures with a high risk of secondary displacement, namely those with severe initial displacement or unsatisfactory reduction.
桡骨远端骨折是儿童最常见的骨折之一。治疗方法首选闭合复位后石膏固定；仅在某些情况下才立即采用克氏针进行骨内固定。文献报道的移位率为 21-39%。本研究旨在回顾性评估在三个不同中心治疗的儿童中，发生骺板骨折继发性移位的危险因素。
所有 360 例患者的初始治疗均为全身麻醉下闭合复位，用肘上石膏固定 4 周。术前、复位后残余移位以及 7 天和 14 天随访时可能发生的移位均进行临床和影像学评估。
102 例报告复位丢失；51 例行额外复位手术——其中一些随后进行了骨内固定——而在其余 51 例中，与预期的重塑相比，复位丢失是可以接受的。发生继发性移位的最具统计学意义的变量是严重的原发性移位。与尺骨骨折的关联没有显著相关性。石膏固定的质量对于维持复位很重要。有一些需要考虑的因素作为进行第二次手术的指标：年龄、骨折发生时间、骨折部位和无法接受的复位。
根据我们的经验，对于有继发性移位高风险的骨折，如初始移位严重或复位不满意的骨折，应考虑采用复位后克氏针骨内固定的治疗方法。
