From the Radiology.
Pediatr Emerg Care. 2024 Aug 1;40(8):e159-e163. doi: 10.1097/PEC.0000000000003177. Epub 2024 Apr 16.
A removable brace with home management is widely accepted treatment for distal radius buckle fractures, which most commonly involve the dorsal cortex.
The purpose of this study is to determine if a removable brace and home management treatment is safe for volar distal radius buckle fractures.
Isolated distal radius buckle fractures in children (3-16 years) diagnosed at an acute care visit (April 1, 2019 to May 31, 2022) were identified. Final diagnosis was confirmed using strict criteria including cortical buckling without cortical breach or physeal involvement. Cortical buckling was categorized as either dorsal or volar. Demographic data, mechanism of injury, treatment, and any complications were recorded and analyzed.
Three hundred thirty-three fractures were either dorsal (254, 76%) or volar (79, 24%) buckle fractures. Mean age (SD) for volar fractures (9.3 [2.2 years]; range, 4-14 years) was significantly higher than for dorsal fractures (8.5 (3.0 years); range, 3-15 years; P = 0.012). More girls had volar fractures (48 [60%], P = 0.006). Most fractures occurred after a standing-height fall. Two hundred forty-four (96%) dorsal and 76 (96%) volar fractures were initially treated with a removable brace. Two hundred fourteen (84%) dorsal and 66 (84%) volar fractures had orthopedic follow-up. Brace treatment continued for 167 (167/204, 82%) dorsal and 56 (56/63, 89%) volar fractures. Treatment changed from initial brace to cast for 37 (37/204, 18%) dorsal fractures and 7 (7/63, 11%) volar fractures, influenced by caregiver preference and/or sport participation requirements. Only 1 (1/79, 1%) patient with a volar fracture returned for an additional visit for persistent pain.
When diagnosis of volar buckle fracture is made using the same strict criteria used for dorsal buckle fractures, removable brace and home management treatment is safe. Shared decision making with caregivers may alter buckle fracture treatment.
带家庭管理的可移动支具被广泛用于治疗桡骨远端扣锁骨折，此类骨折最常涉及背侧皮质。
本研究旨在确定可移动支具和家庭管理治疗对桡骨远端掌侧扣锁骨折是否安全。
在急性就诊时（2019 年 4 月 1 日至 2022 年 5 月 31 日），我们确定了儿童（3-16 岁）孤立性桡骨远端扣锁骨折。最终诊断通过严格的标准进行确认，包括皮质扣锁而无皮质破裂或骺板受累。皮质扣锁分为背侧或掌侧。记录并分析人口统计学数据、损伤机制、治疗方法和任何并发症。
333 例骨折为背侧（254 例，76%）或掌侧（79 例，24%）扣锁骨折。掌侧骨折的平均年龄（标准差）为 9.3（2.2 岁）；范围为 4-14 岁，显著高于背侧骨折的 8.5（3.0 岁）；范围为 3-15 岁；P=0.012）。掌侧骨折中女孩更多（48[60%]，P=0.006）。大多数骨折发生在站立高度跌倒后。244 例（96%）背侧和 76 例（96%）掌侧骨折最初采用可移动支具治疗。214 例（84%）背侧和 66 例（84%）掌侧骨折有矫形随访。167 例（167/204，82%）背侧和 56 例（56/63，89%）掌侧骨折继续使用支具治疗。37 例（37/204，18%）背侧骨折和 7 例（7/63，11%）掌侧骨折的治疗从最初的支具改为石膏，这受照护者偏好和/或运动参与要求的影响。仅有 1 例（1/79，1%）掌侧骨折患者因持续疼痛而再次就诊。
当使用与背侧扣锁骨折相同的严格标准诊断掌侧扣锁骨折时，可移动支具和家庭管理治疗是安全的。与照护者共同决策可能会改变扣锁骨折的治疗方法。
