Rehabilitation Medicine Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Injury. 2023 Dec;54(12):111169. doi: 10.1016/j.injury.2023.111169. Epub 2023 Oct 29.
Open reduction is a therapeutic option for displaced radial neck fracture in children, which once was considered the last resort because of its potential risk for functional outcomes. This study aimed to identify risk factors for open reduction in operatively treated radial neck fractures in children.
One hundred and thirty-seven patients with displaced radial neck fractures, treated surgically at our department from January 2010 to December 2021 were retrospectively enrolled. Patients' data of age, sex, injury side, obesity, type of fractures, combined fractures, nerve injury, reduction methods, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios of open reduction.
Overall, 137 patients (62 females and 75 males) with an average of 8.0 ± 2.2 years were analyzed. There were 62 cases of type III fractures and 75 cases of type IV based on the Judet classification. Thirty-two cases had combined fractures and 19 cases presented with nerve injury. The open reduction rate was 24.1 % (33/137). Univariate analysis indicated obesity, fracture type, and combined fractures were significantly associated with open reduction. (P = 0.039, P = 0.000 and P = 0.000, respectively). While multivariate logistic regression analysis showed that only fracture type (OR, 5.18; CI, 1.63-16.46, p = 0.005) and combined fractures (OR, 7.79; CI, 2.97-20.41, p = 0.000) were independent risk factors for open reduction.
Judet type IV fracture and combined fractures are two significant risk factors for open reduction in operatively treated radial neck fractures in children. These findings will facilitate preoperative decision making, remind surgeons of the risk of failure in closed reduction and the use of new surgical techniques to decrease the open reduction poor outcome rate.
切开复位是儿童移位性桡骨颈骨折的一种治疗选择，由于其功能结果的潜在风险，过去曾被认为是最后的手段。本研究旨在确定儿童手术治疗桡骨颈骨折切开复位的危险因素。
回顾性纳入 2010 年 1 月至 2021 年 12 月在我科接受手术治疗的 137 例移位性桡骨颈骨折患者。回顾患者的年龄、性别、损伤侧、肥胖、骨折类型、合并骨折、神经损伤、复位方法以及从受伤到手术的时间等数据。采用单因素分析和多因素 logistic 回归分析确定切开复位的独立危险因素和优势比。
共有 137 例患者（62 例女性和 75 例男性），平均年龄为 8.0±2.2 岁。根据 Judet 分类，有 62 例 III 型骨折和 75 例 IV 型骨折。32 例合并骨折，19 例伴有神经损伤。切开复位率为 24.1%（33/137）。单因素分析表明，肥胖、骨折类型和合并骨折与切开复位显著相关（P=0.039、P=0.000 和 P=0.000）。而多因素 logistic 回归分析表明，只有骨折类型（OR，5.18；95%CI，1.63-16.46，p=0.005）和合并骨折（OR，7.79；95%CI，2.97-20.41，p=0.000）是儿童手术治疗桡骨颈骨折切开复位的独立危险因素。
Judet Ⅳ型骨折和合并骨折是儿童手术治疗桡骨颈骨折切开复位的两个重要危险因素。这些发现将有助于术前决策，提醒外科医生闭合复位失败的风险，并使用新的手术技术降低切开复位不良结局的发生率。
