Shah Apurva S, Guzek Ryan H, Miller Mark L, Willey Michael C, Mahan Susan T, Bae Donald S
Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
J Pediatr Orthop. 2023 Jan 1;43(1):e1-e8. doi: 10.1097/BPO.0000000000002288. Epub 2022 Oct 26.
More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry.
Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed.
A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male ( P <0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P <0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P <0.001), obese (25.3% vs. 17.2%; P <0.001), and have bicortical fractures (62.2% vs. 14.5%; P <0.001).
Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children.
Level I-prognostic.
超过四分之一的儿童骨折累及桡骨远端。大多数既往的流行病学研究仅限于回顾性的单中心调查，且常纳入成人。本研究旨在利用多中心儿童桡骨远端骨折登记处前瞻性收集的数据，描述儿童桡骨远端骨折的当代流行病学情况。
对2018年6月至2019年12月在4家三级儿科医疗中心被诊断为桡骨远端骨折的4至18岁患者进行筛查，并纳入这项前瞻性纵向队列研究。如果患者出现双侧桡骨远端骨折、多发伤或再次骨折，则将其排除。记录人口统计学信息、损伤机制、骨折特征、相关损伤和治疗信息。对所有X线片进行复查和测量。进行描述性统计和双变量分析。
共纳入1951例患者。平均年龄为9.9±3.3岁，61.3%的患者为男性（P<0.001）。大多数损伤发生在高能坠落（33.5%）或运动参与过程中（28.4%）。骨折发生率最高的月份是春季（38.5%）。青枝骨折（44.0%）比双皮质骨折（31.3%）或骨骺骨折（21.0%）更常见。在骨骺骨折中،84.3%为Salter-Harris II型。51.2%的患者观察到合并尺骨骨折。骨骺骨折患者的平均受伤年龄（11.6±2.9岁）高于青枝骨折或双皮质骨折患者（分别为9.4±3.1岁和9.6±3.1岁；P<0.001）。36%的桡骨远端骨折接受了闭合复位，3.3%接受了手术固定。接受闭合复位治疗的患者更可能为男性（68.7%对57.2%；P<0.001）、肥胖（25.3%对17.2%；P<0.001），且有双皮质骨折（62.2%对14.5%；P<0.001）。
儿童桡骨远端骨折男性居多，最常发生在春季以及高能坠落和运动期间。骨骺骨折往往发生在年龄较大的儿童，而青枝骨折和双皮质骨折往往发生在年龄较小的儿童。
I级-预后性。
