Langenberg Lisette C, van den Ende Kimberly I M, Reijman Max, Boersen G J Juliën, Colaris Joost W
Centre for Orthopedic Research Alkmaar (CORAL), 1815 JD Alkmaar, The Netherlands.
Department of Orthopedic Surgery, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands.
Children (Basel). 2022 Jul 14;9(7):1049. doi: 10.3390/children9071049.
Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.
本综述旨在确定小儿桡骨颈骨折保守治疗可接受的成角范围，以及骨折治疗类型如何影响随访时的活动范围（ROM）。患者与方法：按照PRISMA指南进行系统检索，纳入报告至少5例桡骨颈骨折患儿的骨折成角、治疗细节及ROM且随访至少1年的研究。分析骨折分类、治疗及ROM的数据。结果：共纳入52项研究（2420例儿童）。可从26篇出版物（551例儿童）中提取足够的患者数据，其中352例儿童随访至少1年。成角<30度的骨折闭合复位（CR）后仅1例活动范围受损。成角超过60度的骨折，克氏针固定（Kw）的活动范围明显优于髓内固定（CIMP；Kw活动范围受损9.7%，CIMP为32.6%，p = 0.01）。在超过50%需要切开复位（OR）的病例中，出现了活动度丧失。结论：CR对成角达30度的骨折有效。对于成角超过60度的骨折，Kw固定可能比CIMP固定更具优势。仅在CR和CRIF失败时才应尝试OR。
