Wollkopf Andreas D P, Halbeisen Florian S, Holland-Cunz Stefan G, Mayr Johannes
Department of Pediatric Surgery, University Children's Hospital Basel, 4056 Basel, Switzerland.
Surgical Outcome Research Center Basel, University Hospital Basel, University Basel, 4053 Basel, Switzerland.
Children (Basel). 2023 Feb 14;10(2):374. doi: 10.3390/children10020374.
Diametaphyseal forearm fractures are difficult to treat because standard methods for long-bone fracture stabilization in the metaphyseal or diaphyseal regions are less effective in this transition zone. We hypothesized that there is no difference in outcomes between conservative and surgical treatment of diametaphyseal forearm fractures. This retrospective analysis included 132 patients who had undergone treatment for diametaphyseal forearm fracture between 2013 and 2020 at our institution. The primary analysis compared complications occurring in patients treated conservatively with those occurring in patients managed surgically (ESIN, K-wire fixation, KESIN stabilization, or open reduction and plate osteosynthesis). In a subgroup analysis, we compared the two most frequently applied surgical stabilization techniques in distal forearm fractures (i.e., ESIN and K-wire) with conservative treatment. The mean age of the patients at the time of intervention was 9.43 ± 3.78 years (mean ± SD). Most patients were male (91; 68.9%), and 70 of 132 (53.1%) patients underwent surgical stabilization. The rate of re-intervention or complications was similar after conservative and surgical treatment, and ESIN or K-wire fixation achieved comparable complication rates. Recurrent displacement of fragments was the most frequent reason for re-interventions (13 of 15 patients; 86.6%). There was no permanent damage as a result of a complication. The median time of exposure to image intensifier radiation was comparable between ESIN (95.5 s) and K-wire fixation (85.0 s), but significantly lower during conservative treatment (15.0 s; = .001).
尺桡骨干骺端骨折难以治疗，因为用于长骨干骺端或骨干区域骨折固定的标准方法在这个过渡区域效果较差。我们假设尺桡骨干骺端骨折的保守治疗和手术治疗在疗效上没有差异。这项回顾性分析纳入了2013年至2020年期间在我们机构接受尺桡骨干骺端骨折治疗的132例患者。主要分析比较了保守治疗患者和手术治疗患者（弹性髓内钉固定、克氏针固定、KESIN固定或切开复位钢板内固定）发生的并发症。在亚组分析中，我们比较了前臂远端骨折最常用的两种手术固定技术（即弹性髓内钉和克氏针）与保守治疗的效果。干预时患者的平均年龄为9.43±3.78岁（均值±标准差）。大多数患者为男性（91例；68.9%），132例患者中有70例（53.1%）接受了手术固定。保守治疗和手术治疗后再次干预或并发症的发生率相似，弹性髓内钉或克氏针固定的并发症发生率相当。骨折块反复移位是再次干预的最常见原因（15例患者中有13例；86.6%）。没有并发症导致永久性损伤。弹性髓内钉组（95.5秒）和克氏针固定组（85.0秒）的影像增强器辐射暴露中位时间相当，但保守治疗期间显著更低（15.0秒；P = .001）。
