Knopp Brandon W, Harris Matthew
Endocrinology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Orthopedic Surgery, Jupiter Medical Center, Jupiter, USA.
Cureus. 2023 Feb 7;15(2):e34741. doi: 10.7759/cureus.34741. eCollection 2023 Feb.
Background This study was conducted to investigate the characteristics, complications, radiologic features, and clinical course of patients undergoing reduction of forearm fractures to better inform patient prognosis and postoperative management. Methodology We conducted a retrospective chart review of 75 pediatric patients treated for forearm fractures between January 2014 and September 2021 in a 327-bed regional medical center. A preoperative radiological assessment and chart review was performed. Percent fracture displacement, location, orientation, comminution, fracture line visibility, and angle of angulation were determined by anteroposterior (AP) and lateral radiographs. Percent fracture displacement was calculated as 𝐵𝑜𝑛𝑒 𝑆ℎ𝑎𝑓𝑡 𝐷𝑖𝑠𝑝𝑙𝑎𝑐𝑒𝑚𝑒𝑛𝑡 / 𝐷𝑖𝑎𝑚𝑒𝑡𝑒𝑟 × 100% = % 𝐷𝑖𝑠𝑝𝑙𝑎𝑐𝑒𝑚𝑒𝑛𝑡. The angle of angulation and percent fracture displacement were calculated by averaging AP and lateral radiograph measurements. Results A total of 75 cases, averaging 11.6 ± 4.1 years, were identified as having a complete fracture of the radius and/or ulna, with 66 receiving closed reduction and nine receiving fixation via an intramedullary device or percutaneous pinning. Eight (10.7%) patients experienced complications, with four resulting in a refracture and four resulting in significant loss of reduction without refracture. Fractures in the proximal two-thirds of the radius were associated with a significant increase in complications compared to fractures in the distal one-third of the radius (33.3% vs 3.6%) (p = 0.0005). Likewise, a greater fracture displacement percentage was associated with a lower risk of refracture post-reduction as those experiencing complications had over 30% greater total displacement pre-reduction compared to patients who did not experience complications such as refracture or loss of reduction (p < 0.0001). No elevated risk of complications was found based on fracture orientation, angulation, fracture line visibility, forearm bone(s) fractured, sex, age, or arm affected. Conclusions Our results highlight radius fracture location and percent fracture displacement as markers with prognostic value following forearm fracture. These measurements are simply calculated via pre-reduction radiographs, providing an efficient method of informing the risk of complications following forearm fracture reduction.
背景 本研究旨在调查接受前臂骨折复位患者的特征、并发症、放射学特征及临床病程，以更好地为患者预后及术后管理提供信息。方法 我们对一家拥有327张床位的地区医疗中心在2014年1月至2021年9月期间治疗的75例小儿前臂骨折患者进行了回顾性病历审查。进行了术前放射学评估及病历审查。通过前后位（AP）和侧位X线片确定骨折移位百分比、位置、方向、粉碎程度、骨折线可见性及成角角度。骨折移位百分比计算为骨干移位/直径×100% =移位百分比。成角角度及骨折移位百分比通过平均AP和侧位X线片测量值来计算。结果 共确定75例患者，平均年龄11.6±4.1岁，患有桡骨和/或尺骨完全骨折，其中66例接受了闭合复位，9例通过髓内装置或经皮穿针固定。8例（10.7%）患者出现并发症，4例导致再骨折，4例导致复位显著丢失但未再骨折。与桡骨远端三分之一处骨折相比，桡骨近端三分之二处骨折的并发症显著增加（33.3%对3.6%）（p = 0.0005）。同样，更大的骨折移位百分比与复位后再骨折风险较低相关，因为出现并发症的患者复位前的总移位比未出现诸如再骨折或复位丢失等并发症的患者大30%以上（p < 0.0001）。基于骨折方向、成角、骨折线可见性、骨折的前臂骨、性别、年龄或受累手臂未发现并发症风险升高。结论 我们的结果强调桡骨骨折位置及骨折移位百分比是前臂骨折后具有预后价值的标志物。这些测量值可通过复位前X线片简单计算得出，为告知前臂骨折复位后并发症风险提供了一种有效方法。
