Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Emerg Care. 2023 Sep 1;39(9):702-706. doi: 10.1097/PEC.0000000000002805. Epub 2022 Aug 6.
This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery.
This retrospective cohort study included all patients aged 0 to 18 years who presented to our pediatric ED with an extraarticular forearm fracture treated with closed reduction between May 2017 and April 2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt.
Of 375 patients (median age 8.1 years, 294 [78.2%] boys), 44 (11.7%) patients sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, P < 0.001), open fracture (aOR 10.1, P = 0.007), midshaft fracture (aOR 2.6, P = 0.004), radial translation rate 37% and higher in either plane (aOR 5.1, P = 0.004), and age of 10 years and older (aOR 2.9, P = 0.01).
Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.
本研究旨在探讨小儿急诊科（ED）闭合复位失败的危险因素，并提出初始手术的适应证。
本回顾性队列研究纳入了 2017 年 5 月至 2021 年 4 月期间因关节外前臂骨折在我院儿科 ED 接受闭合复位治疗的 0 至 18 岁患者。我们探讨了手术失败的危险因素，定义为闭合复位后 6 周内需要手术干预。
在 375 名患者（中位年龄 8.1 岁，294 名男孩[78.2%]）中，有 44 名（11.7%）患者发生复位失败，其中 42 名（95.5%）为尺桡骨双骨折。在 259 例尺桡骨双骨折患者中，以下参数为复位失败的独立预测因素：再骨折（校正优势比[aOR] 17.6，P<0.001）、开放性骨折（aOR 10.1，P=0.007）、骨干骨折（aOR 2.6，P=0.004）、任一平面桡骨移位率 37%及以上（aOR 5.1，P=0.004）、年龄 10 岁及以上（aOR 2.9，P=0.01）。
大多数小儿前臂骨折可在 ED 行闭合复位成功治疗。双骨折与复位失败的关联最强。再骨折、开放性骨折、骨干部位、初始桡骨骨移位率 37%及以上（而非初始成角）和患者年龄 10 岁及以上是双骨折复位失败的独立危险因素。我们提出了一个复位失败的风险评分，可以作为决策工具。
