Leuba Aline, Ceroni Dimitri, Tabard-Fougère Anne, Lutz Nicolas
Pediatric Trauma and Orthopaedic Unit, University Hospital of Lausanne, Switzerland.
Service of Pediatric Orthopaedics, University Hospital of Geneva, Geneva, Switzerland.
J Child Orthop. 2022 Jun;16(3):220-226. doi: 10.1177/18632521221106380. Epub 2022 Jun 30.
Flexible intramedullary nailing is regularly applied for pediatric displaced unstable forearm fractures. When compared to closed reduction and casting (orthopedic treatment), flexible intramedullary nailing decreases malalignment, shortens immobilization time, and should decrease follow-up controls. Comparing flexible intramedullary nailing and orthopedic treatment in the clinical, radiological, and financial managements of these fractures was performed.
Retrospective 5 years study of pediatric cases in two pediatric orthopedic university departments. Treatment method, post-operative course, and radiological follow-up were reviewed. Number of radiographs, follow-up controls, type and duration of immobilization, final bone angulation, and reported complications were compared. Extensive financial analysis was completed.
Of 73 girls and 168 boys included in the study, 150 were treated by flexible intramedullary nailing and 91 by orthopedic treatment. No difference was noted with regard to total number of radiographs (7.3 vs 7.2, respectively). Total number of follow-ups was 6.4 and 5.5, respectively. Malalignment occurred in two flexible intramedullary nailing and sixteen orthopedic treatments. The least expensive cost was ambulatory orthopedic treatment.
Flexible intramedullary nailing treated children had similar numbers of radiographs or follow-up consultation, but less malunion when compared to orthopedic treatment. Orthopedic management was systematically cheaper than flexible intramedullary nailing. Unless post-operative management guidelines decreasing the number of radiographs and follow-ups are implemented, flexible intramedullary nailing will remain a costly procedure when compared to conventional orthopedic treatment.
level III case-control retrospective study.
弹性髓内钉常用于治疗小儿移位不稳定型前臂骨折。与闭合复位及石膏固定（骨科治疗）相比，弹性髓内钉可减少畸形愈合、缩短固定时间，并减少随访次数。本研究对弹性髓内钉与骨科治疗在这些骨折的临床、影像学及费用管理方面进行了比较。
对两所大学小儿骨科科室5年的小儿病例进行回顾性研究。回顾治疗方法、术后病程及影像学随访情况。比较X线片数量、随访次数、固定类型及持续时间、最终骨成角情况及报告的并发症。完成了全面的费用分析。
纳入研究的73名女孩和168名男孩中，150例采用弹性髓内钉治疗，91例采用骨科治疗。X线片总数无差异（分别为7.3次和7.2次）。随访总数分别为6.4次和5.5次。弹性髓内钉治疗组有2例出现畸形愈合，骨科治疗组有16例。费用最低的是门诊骨科治疗。
与骨科治疗相比，采用弹性髓内钉治疗的儿童X线片数量或随访咨询次数相似，但骨不连情况较少。骨科治疗总体上比弹性髓内钉治疗费用更低。除非实施减少X线片数量和随访次数的术后管理指南，否则与传统骨科治疗相比，弹性髓内钉治疗仍将是一种昂贵的治疗方法。
III级病例对照回顾性研究。
