Chen Stephen, LaBarge Matthew E, Henry Abigail L, Pennings Jacquelyn, Martus Jeffrey E
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Pediatr Orthop. 2025 Mar 1;45(3):e218-e223. doi: 10.1097/BPO.0000000000002853. Epub 2024 Oct 24.
Greater understanding of the impact of skeletal maturity on outcomes is needed to guide operative treatment of diaphyseal forearm fractures in children and adolescents. The purpose of this study was to compare the complications and outcomes of pediatric diaphyseal forearm fractures treated with intramedullary nailing (IMN) or open reduction internal fixation (ORIF) and to identify a radiographic marker of skeletal maturity that will aid in selecting between treatment options.
A retrospective review of patients aged 10 to 16 years treated operatively for diaphyseal forearm fractures was performed. Markers of skeletal maturity including the olecranon apophysis score, the presence of the thumb adductor sesamoid, and radial epiphyseal capping. Complications were graded with the modified Clavien-Dindo system. Outcomes were scored based on final postoperative range of motion combined with complication grade.
A total of 260 patients were included: 163 treated with IMN, 97 treated with ORIF, mean age 12.7 years, 72% male. Among closed forearm fractures treated with IMN, open reduction was required in 45% (53/118). Patients treated with IMN had a higher complication rate than ORIF (27.0% vs. 9.3%, P <0.05), including when stratified by age. Complication rates were not impacted by greater skeletal maturity as indicated by the presence of thumb sesamoid or radial epiphyseal capping. There was no significant difference in outcomes between the ORIF and IMN groups. More skeletally immature patients, as identified by a lack of either the thumb adductor sesamoid or radial epiphyseal capping, had significantly better outcomes with ORIF than patients with greater maturity.
Across all age groups and levels of skeletal maturity, ORIF had a significantly lower rates of complications compared with IMN with equivalent outcomes. More skeletally immature patients had significantly better outcomes with ORIF treatment when compared with older patients. The thumb adductor sesamoid, radial epiphyseal capping, and the olecranon apophysis score did not provide useful information to select between ORIF over IMN in this population.
Level III-retrospective comparative study.
为指导儿童和青少年肱骨干骨折的手术治疗，需要更深入了解骨骼成熟度对治疗结果的影响。本研究的目的是比较髓内钉固定（IMN）或切开复位内固定（ORIF）治疗小儿肱骨干骨折的并发症和治疗结果，并确定一种有助于选择治疗方案的骨骼成熟度影像学标志物。
对10至16岁接受肱骨干骨折手术治疗的患者进行回顾性研究。骨骼成熟度的标志物包括鹰嘴骨骺评分、拇指内收籽骨的存在情况以及桡骨骨骺覆盖情况。并发症采用改良的Clavien-Dindo系统分级。根据术后最终活动范围结合并发症分级对治疗结果进行评分。
共纳入260例患者：163例接受IMN治疗，97例接受ORIF治疗，平均年龄12.7岁，男性占72%。在接受IMN治疗的闭合性前臂骨折中，45%（53/118）需要切开复位。接受IMN治疗的患者并发症发生率高于ORIF治疗（27.0%对9.3%，P<0.05），按年龄分层时也是如此。拇指籽骨或桡骨骨骺覆盖情况所表明的更高骨骼成熟度并未影响并发症发生率。ORIF组和IMN组的治疗结果无显著差异。通过缺乏拇指内收籽骨或桡骨骨骺覆盖确定的骨骼成熟度较低的患者，ORIF治疗的结果明显优于成熟度较高的患者。
在所有年龄组和骨骼成熟度水平上，ORIF与IMN相比并发症发生率显著更低，且治疗结果相当。与年龄较大的患者相比，骨骼成熟度较低的患者接受ORIF治疗的结果明显更好。在该人群中，拇指内收籽骨、桡骨骨骺覆盖情况和鹰嘴骨骺评分对于在ORIF和IMN之间进行选择并无有用信息。
III级——回顾性比较研究。
