Kalbitz Miriam, Lackner Ina, Perl Mario, Pressmar Jochen
Department of Trauma and Orthopedic Surgery, Friedrich-Alexander University Erlangen-Nurnberg, University Hospital Erlangen, Erlangen, Germany.
Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Centre of Surgery, University of Ulm, Ulm, Germany.
Front Pediatr. 2023 Jan 20;10:988372. doi: 10.3389/fped.2022.988372. eCollection 2022.
Radial head and neck fractures are a rare entity in pediatric patients. Due to specific characteristics of the blood supply and remodeling potential, the correct diagnosis and initiation of appropriate therapy are crucial for the outcome. Therefore, the aim of this retrospective observational study was to present the outcome of a series of pediatric patients with radial head and neck fractures.
In total, 67 pediatric and adolescent patients with a fracture of the proximal radius admitted to a Level I Trauma Center (Germany) between 2005 and 2017 were included in this retrospective observational study. Patients were stratified in accordance with the classification of Judet modified by Metaizeau and with the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).
AO-PCCF fracture type of proximal radius was age-dependent. Epiphyseal axis angle and displacement angle correlated significantly. Fractures treated with a K-wire or embrochage centromedullaire elastique stable (ECMES) presented higher displacement angles. The duration of callus formation was dependent on both the reduction technique and fracture displacement. The range of motion after complete fracture consolidation was dependent on the Metaizeau type and reduction technique but independent of the duration of immobilization and physical therapy.
Both the epiphyseal axis and displacement angle are suitable for measuring the initial fracture displacement in radiographs. Consolidation is dependent on the initial displacement and reduction technique. The mini-open approach leads to a worse reduction result, later callus formation, and a more restricted range of motion in terms of pronation. Furthermore, the range of motion at follow-up is independent of the duration of immobilization and physiotherapy.
桡骨头和颈部骨折在儿科患者中较为罕见。由于血液供应和重塑潜力的特定特征，正确的诊断和开始适当的治疗对于预后至关重要。因此，这项回顾性观察性研究的目的是展示一系列儿科桡骨头和颈部骨折患者的预后情况。
本回顾性观察性研究纳入了2005年至2017年间入住一级创伤中心（德国）的67例桡骨近端骨折的儿科和青少年患者。患者根据Metaizeau修改的Judet分类法和AO儿童长骨骨折综合分类法（AO-PCCF）进行分层。
桡骨近端的AO-PCCF骨折类型与年龄相关。骨骺轴角和移位角显著相关。用克氏针或弹性髓内钉固定（ECMES）治疗的骨折呈现出更高的移位角。骨痂形成的持续时间取决于复位技术和骨折移位情况。骨折完全愈合后的活动范围取决于Metaizeau类型和复位技术，但与固定和物理治疗的持续时间无关。
骨骺轴角和移位角均适用于在X线片上测量初始骨折移位。愈合情况取决于初始移位和复位技术。小切口手术导致复位效果较差、骨痂形成较晚以及旋前活动范围更受限。此外，随访时的活动范围与固定和物理治疗的持续时间无关。
