From the Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany.
Pediatr Emerg Care. 2024 Jan 1;40(1):2-5. doi: 10.1097/PEC.0000000000002924. Epub 2023 Mar 13.
Buckle fractures of the distal forearm are a common fracture entity in children treated conservatively. Diagnostics primarily include radiographs in 2 planes. Inadequate images may occur in the mostly very young patients. Therefore, additional lateral radiographs are often obtained to assess a possible angular tilt. The aim of this study is to investigate whether a strictly lateral x-ray image has an influence on fracture management.
Seventy-three children with buckle fractures of the distal forearm were included in this retrospective analysis. All cases were analyzed by quality of radiographs, necessity to obtain an additional lateral radiograph, and what influence on fracture management resulted. Follow-up was performed 2 to 4 weeks after immobilization.
Thirty-five girls and 38 boys with a mean age of 7.16 years were included; 40 had fractured right and 33 had fractured left arms, respectively. Isolated distal radius fractures occurred in 48 cases, isolated distal ulna fractures in 6 cases, and both bones in 19 cases. Initial radiographic images were evaluated as inadequate in 25 cases. In each of those cases, an additional lateral image was obtained by fluoroscopy without resulting in an alternated fracture management protocol, which was chosen conservatively in each case and resulted in excellent clinical outcome at follow-up examination.
Based on our results, the acquisition of additional lateral radiographs seems to be unnecessary in the diagnostic procedure of buckle fractures of the distal forearm, in case a possible palmar or dorsal angulation cannot be entirely assessed on the initial set of radiographs. An additional lateral image had no influence on fracture management, which was chosen conservatively in every case and led to excellent clinical results.Level of evidence: level III.
儿童保守治疗的下前臂扣带骨折是一种常见的骨折类型。诊断主要包括两个平面的 X 光片。在大多数非常年幼的患者中，图像可能不充分。因此，通常会获得额外的侧位 X 光片来评估可能的角度倾斜。本研究旨在探讨是否严格的侧位 X 光片会影响骨折处理。
本回顾性分析纳入了 73 例下前臂扣带骨折的儿童。所有病例均通过 X 光片质量、获得额外侧位 X 光片的必要性以及对骨折处理的影响进行分析。在固定后 2 至 4 周进行随访。
共纳入 35 名女孩和 38 名男孩，平均年龄为 7.16 岁；40 例右臂骨折，33 例左臂骨折。单纯桡骨远端骨折 48 例，单纯尺骨远端骨折 6 例，尺桡骨均骨折 19 例。25 例初始 X 光片评估为不充分。在这些病例中，每例均通过透视获得额外的侧位 X 光片，但没有改变骨折处理方案，所有病例均选择保守治疗，随访时临床结果均良好。
根据我们的结果，在诊断下前臂扣带骨折时，如果初始 X 光片不能完全评估掌侧或背侧成角，那么获取额外的侧位 X 光片似乎是不必要的。额外的侧位 X 光片对骨折处理没有影响，所有病例均选择保守治疗，临床结果良好。证据水平：III 级。
