小儿前臂骨折非手术治疗失败的可改变和不可改变风险因素：我们在哪些方面可以做得更好？

Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?

作者信息

Talathi Nakul S, Shi Brendan, Policht Jeremy, Mooney Bailey, Chen Kevin Y, Silva Mauricio, Thompson Rachel M

机构信息

Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.

Luskin Orthopaedic Institute for Children, Los Angeles, CA, USA.

出版信息

J Child Orthop. 2023 Jun 28;17(4):332-338. doi: 10.1177/18632521231182420. eCollection 2023 Aug.

DOI:10.1177/18632521231182420

PMID:37565009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10411376/

Abstract

INTRODUCTION

Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction.

METHODS

We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups.

RESULTS

A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis.

CONCLUSION

Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population.

LEVEL OF EVIDENCE

level III Case Control Study.

摘要

引言

儿童前臂远端三分之一骨折是常见骨折。虽然总体预后良好，但一些患者初始非手术治疗失败，需要干预。本研究的目的是确定与闭合复位失败相关的独立危险因素。

方法

我们对接受闭合复位和石膏固定治疗的儿童前臂远端三分之一骨折进行了回顾性研究。患者分为两组，即成功闭合复位组和初始非手术治疗失败组。分析两组之间的人口统计学特征、石膏类型、石膏指数、影像学骨折、软组织特征和复位质量。

结果

共有207例接受前臂远端三分之一骨折治疗的儿童纳入分析。共有190例（91.8%）儿童维持了复位，而17例（8.2%）初始非手术治疗失败。单因素分析中与复位丢失相关的可改变危险因素包括使用长臂石膏（p = 0.003）、复位后移位增加（p = 0.02）和复位后成角畸形增加（p = 0.01）。不可改变的危险因素包括体重指数增加（p = 0.02）、骨折移位增加（p = 0.002）和骨折部位软组织包膜宽度增加（p = 0.0001）。多因素分析后，使用长臂石膏（13%对2%，比值比 = 6.44）和软组织宽度（60.6对50.4 mm，比值比 = 1.1）仍然是复位丢失的显著危险因素。