Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland.
Department Orthopaedic Surgery and Traumatology, Popiełuszko Memorial Bielański Hospital, Warsaw, Poland.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6649-6656. doi: 10.1007/s00402-023-04996-7. Epub 2023 Jul 31.
Distal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures.
One hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien-Dindo-Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites.
Forty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery-deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common-40 wrists (33,6%).
The CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient's postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.
桡骨远端骨折（DRF）是最常见的儿童骨折，但目前管理的证据仍不确定。闭合复位经皮克氏针固定（CRPP）提供了极好的稳定性，但并非没有并发症。因此，需要对其不良事件进行全面评估，以便在不同临床情况下提供有关风险和益处的可靠信息。目前的文献缺乏使用严格的分级系统和统一的随访方案对此主题进行的研究。本前瞻性队列研究使用经过验证的分级方案，对未经选择的儿童移位性、不稳定的桡骨远端三分之一骨折患者进行 CRPP 治疗相关并发症进行分析。
119 例 DRF（116 例患者）接受 CRPP 治疗，纳入本研究。所有患者均在手术后 4 周、5 周、3 个月和 6 个月进行随访。整个研究中使用相同的方案，包括结构化病史、体格检查和影像学评估。所有数据均前瞻性提取。采用 Clavien-Dindo-Sink 分级系统评估并发症，采用 Dahl 评分评估针道。
42 例腕部（35.3%）出现 CDS Ⅰ级或Ⅱ级并发症，2 例（1.7%）出现 Ⅲ级并发症。研究组的总体并发症发生率为 37%（44 例并发症）。2 例患者需要再次手术-深部骨针道感染采用 Masquelet 技术治疗，以及移位针的手术取出。在轻微并发症中，针道炎症最常见-40 例（33.6%）。
CRPP 是儿童患者 DRF 的安全治疗方法，主要并发症发生率低。然而，轻微的不良事件很常见，会显著影响患者的术后舒适度。严格定义和分级系统的应用不仅应导致获得高质量数据，而且还应提高对可能的针道感染的认识，从而做出更好的治疗决策。
