Perhomaa Marja, Stöckell Markus, Pokka Tytti, Lieber Justus, Niinimäki Jaakko, Sinikumpu Juha-Jaakko
Research Unit of Clinical Medicine, Medical Research Center, Oulu Childhood Fracture and Sports Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, (MRC) Oulu, Oulu University Hospital, Oulu University, 90220 Oulu, Finland.
Research Unit of Health Sciences and Technology, Department of Radiology, Oulu University Hospital, Oulu University, 90220 Oulu, Finland.
Children (Basel). 2023 Feb 9;10(2):339. doi: 10.3390/children10020339.
Distal forearm fractures are common in children and are usually treated nonoperatively. No consensus has been reached on how to perform clinical and radiographic follow-up of these fractures. Our aim was to study whether radiographic and clinical follow-up is justified. We included 100 consecutive patients with non-operatively treated distal forearm fractures who were treated at Oulu University Hospital in 2010-2011. The natural history of the fractures during the nonoperative treatment was analyzed by measuring the potential worsening of the alignment during the follow-up period. The limits of acceptable fracture position were set according to the current literature using "strict" or "wide" criteria for alignment. We determined the rate of worsening fracture position (i.e., patients who reached the threshold of unacceptable alignment). In relation to splinting, we evaluated how many patients benefited from clinical follow-up. Most of the fractures (98%) preserved acceptable alignment during the entire follow-up period when wide criteria were used. The application of stricter criteria for alignment in radiographs showed loss of reduction in 19% of the fractures. Worsening of the alignment was recognized at a mean of 13 days (range 5-29) after the injury. One in three (32%) patients needed some intervention due to splint loosening or failure. Radiographic follow-up of nonoperatively treated distal forearm fractures remains questionable. Instead, clinical follow-up is important, as 32% of patients needed their splints fixed.
儿童前臂远端骨折很常见，通常采用非手术治疗。对于如何对这些骨折进行临床和影像学随访，目前尚未达成共识。我们的目的是研究影像学和临床随访是否合理。我们纳入了2010年至2011年在奥卢大学医院接受非手术治疗的100例连续的前臂远端骨折患者。通过测量随访期间骨折对线可能出现的恶化情况，分析非手术治疗期间骨折的自然病程。根据当前文献，使用“严格”或“宽松”的对线标准来设定可接受的骨折位置界限。我们确定了骨折位置恶化的发生率（即达到不可接受对线阈值的患者）。关于夹板固定，我们评估了有多少患者从临床随访中获益。当使用宽松标准时，大多数骨折（98%）在整个随访期间保持了可接受的对线。在X线片上应用更严格的对线标准显示，19%的骨折出现了复位丢失。骨折对线恶化在受伤后平均13天（范围5 - 29天）被发现。三分之一（32%）的患者因夹板松动或失效需要进行某种干预。非手术治疗的前臂远端骨折的影像学随访仍然存在疑问。相反，临床随访很重要，因为32%的患者需要固定他们的夹板。
