From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
J Am Acad Orthop Surg. 2024 Nov 1;32(21):e1079-e1089. doi: 10.5435/JAAOS-D-23-01233. Epub 2024 May 29.
Distal radius fractures are the most common skeletal injuries requiring intervention in children. These injuries are classified by fracture pattern, location, displacement, and angulation. While each unique fracture pattern warrants slightly modified treatment plans and follow-up, the goals of treatment remain constant. Successful outcomes depend on restoration of motion and function, and attaining acceptable sagittal and coronal alignment is a necessary first step. For displaced fractures, closed reduction is often necessary to restore alignment; well-molded cast application is important to maintain fracture alignment. Fractures with bayonet apposition, if well aligned, may not need formal reduction in some patients. Special attention should be paid to the physis-not only for physeal-involving fractures but also for all distal radius fractures-given that the proximity to the physis and amount of remaining skeletal growth help guide treatment decisions. Casting technique is essential in optimizing the best chance in maintaining fracture reduction. Surgical intervention may be indicated for a subset of fractures when acceptable alignment is not achieved or is lost at subsequent follow-up. Even among experts in the field, there is little consensus as to the optimal treatment of displaced metaphyseal fractures, illustrating the need for prospective, randomized studies to establish best practices.
桡骨远端骨折是儿童最常见需要干预的骨骼损伤。这些损伤根据骨折模式、位置、移位和角度进行分类。虽然每种独特的骨折模式都需要略微修改治疗计划和随访，但治疗的目标保持不变。成功的结果取决于运动和功能的恢复，获得可接受的矢状面和冠状面排列是必要的第一步。对于移位的骨折，通常需要闭合复位来恢复对线；良好塑形的石膏固定对于维持骨折对线非常重要。对于贝氏错位的骨折，如果对线良好，在某些患者中可能不需要正式复位。由于靠近骺板和剩余的骨骼生长量，应特别注意骺板——不仅对于涉及骺板的骨折，而且对于所有桡骨远端骨折——这有助于指导治疗决策。铸型技术对于优化维持骨折复位的最佳机会至关重要。对于某些无法达到或随后随访时丢失可接受对线的骨折，可能需要手术干预。即使在该领域的专家中，对于移位干骺端骨折的最佳治疗方法也几乎没有共识，这表明需要进行前瞻性、随机研究来确定最佳实践。
