Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Child Health Research Centre, University of Queensland, Queensland, Australia.
Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.
Injury. 2024 Nov;55(11):111897. doi: 10.1016/j.injury.2024.111897. Epub 2024 Sep 17.
Distal forearm fractures are common in children and adolescents with a spectrum of severity. There are fracture patterns that are suitable for minimal interventions, such as a splint or bandage. The objective of this review was to identify which types of paediatric distal forearm fractures can be safely and effectively managed with a removable splint or bandage.
A scoping review was performed. Databases searched were PubMed, Embase, The Cochrane Library and CINAHL; two trial registries were also searched. All primary study designs with children <18 years of age with a distal forearm fracture that was managed in either a splint or bandage were included. Quality of evidence was determined using the GRADE tool.
Twenty-two eligible articles were included from 20 unique studies: 12 randomised controlled trials, seven cohort studies and a case report. Twelve studies focused solely on buckle/torus fractures, with remaining studies including other fracture types, such as incomplete ('greenstick'), complete ('transverse'), or physeal (Salter-Harris). Twelve studies reported that participants with either bandage or splint had appropriate reduction in pain and recovery of function at completion of follow-up for all fracture types. All 20 studies reported minimal adverse events related to fracture management. One study reported worsening angulation with bandage immobilisation for complete fractures in two participants, which required manipulation under anaesthesia.
There is high quality evidence to support the safety and effectiveness of a splint or bandage for treatment of distal radius buckle and non-displaced incomplete fractures. Several studies supported the use of minimal interventions for various distal radius cortical breach fracture types, with good outcomes, but were limited by heterogeneity (methodology, interventions, outcome measures, reference standard) and potential bias.
Included studies confirmed the inherent stability of buckle fractures. The current literature gap to support minimal interventions for a range of other paediatric distal forearm fracture types was highlighted. High-quality evidence with well-designed, large, multicentre randomised control trials in defined age groups is required to identify which paediatric distal forearm fractures can be safely and effectively managed with either a removable splint or bandage.
儿童和青少年的前臂远端骨折较为常见，其严重程度不一。有一些骨折类型适合采用微创治疗，如夹板或绷带固定。本综述的目的是确定哪些类型的儿童前臂远端骨折可以安全有效地采用可移动夹板或绷带进行治疗。
进行了范围界定综述。检索的数据库包括 PubMed、Embase、Cochrane 图书馆和 CINAHL；还检索了两个试验注册处。纳入的所有研究设计均为采用夹板或绷带治疗的年龄<18 岁的儿童前臂远端骨折的原始研究。使用 GRADE 工具确定证据质量。
从 20 项研究中纳入了 22 篇符合条件的文章：12 项随机对照试验、7 项队列研究和 1 项病例报告。12 项研究仅专注于 buckle/torus 骨折，其余研究包括其他骨折类型，如不完全（“青枝”）、完全（“横断”）或骺板（Salter-Harris）骨折。12 项研究报告称，对于所有骨折类型，使用绷带或夹板的参与者在完成随访时疼痛减轻且功能恢复适当。20 项研究均报告与骨折管理相关的轻微不良事件。一项研究报告称，在 2 名参与者中，完全骨折采用绷带固定后出现角度恶化，需要在全身麻醉下进行手法复位。
有高质量证据支持夹板或绷带治疗桡骨远端 buckle 和无移位不完全骨折的安全性和有效性。一些研究支持对各种桡骨远端皮质破裂骨折类型采用微创治疗，结果良好，但受到异质性（方法、干预、结局测量、参考标准）和潜在偏倚的限制。
纳入的研究证实了 buckle 骨折的固有稳定性。目前的文献差距在于支持对一系列其他儿童前臂远端骨折类型采用微创治疗。需要在明确年龄组中开展高质量、精心设计、多中心的随机对照试验，以确定哪些儿童前臂远端骨折可以安全有效地采用可移动夹板或绷带进行治疗。
