von Schrottenberg Christoph, Beck Ricardo, Beck Susann Marie, Kruppa Christian, Kuhn Matthias, Schwerk Philipp, Fitze Guido, Schultz Jurek
Department of Pediatric Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße, 74, 01307, Dresden, Germany.
Institute for Medical Informatics and Biometry, Faculty of Medicine, Technical University Carl Gustav Carus, Dresden, Germany.
Arch Orthop Trauma Surg. 2025 Jan 7;145(1):115. doi: 10.1007/s00402-024-05664-0.
Unstable diametaphyseal radius fractures (DMRFs) can be prone to complications, and treatment strategies are heterogeneous. Studies are difficult to interpret as definitions of the diametaphyseal junction zone (DMJZ) are impractical for clinical use, imprecise, or prone to error.
We introduce the forearm fracture index (FFI) to define DMRFs in radiographs and ultrasound. The FFI is calculated by the ratio of the fracture's distance to the distal radius growth plate over the width of the radius growth plate. The higher the FFI, the more proximal the fracture is. We define DMRFs to have an FFI between 1 and 2. All DMRFs treated at our institution between 2010 and 2020 were identified, and demographic data, fracture characteristics, and therapeutic strategies were assessed retrospectively. Comparative sub-analysis was performed between DMRFs(-) as defined in previous publications (Lieber in Unfallchirurg 114:292-299, 2011) and DMRFs( +) that were more proximal but still met our criteria.
516 DMRFs were identified, representing 13.0% of all screened radius fractures. Excluding buckle fractures and patients lost to follow-up, 366 DMRFs were eligible for further analysis. Conservatively managed DMRFs were more distal than those managed operatively, represented by a lower FFI (1.28 vs. 1.34, p = 0.0051). 21 (5.7%) of all DMRFs were identified as DMRFs( +). These were significantly more dislocated and necessitated surgery more often than DMRFs(-) (52.4 vs. 24.6%, p = 0.009).
The FFI may be a good tool to identify and describe DMRFs. It can help guiding treatment decisions and make future studies on this entity more comparable.
Study of Diagnostic Test, Level II.
不稳定的桡骨干骺端骨折（DMRF）容易出现并发症，且治疗策略多种多样。由于干骺端交界区（DMJZ）的定义在临床应用中不实用、不准确或容易出错，因此研究难以解读。
我们引入前臂骨折指数（FFI）来在X线片和超声中定义DMRF。FFI通过骨折到桡骨远端生长板的距离与桡骨生长板宽度的比值计算得出。FFI越高，骨折越靠近近端。我们将DMRF定义为FFI在1到2之间。确定了2010年至2020年间在我们机构接受治疗的所有DMRF，并回顾性评估了人口统计学数据、骨折特征和治疗策略。对先前出版物（Lieber于《Unfallchirurg》2011年第114卷：292 - 299页）中定义的DMRF（-）和更靠近近端但仍符合我们标准的DMRF（+）进行了比较亚分析。
共识别出516例DMRF，占所有筛查的桡骨骨折的13.0%。排除青枝骨折和失访患者后，366例DMRF符合进一步分析条件。保守治疗的DMRF比手术治疗的更靠近远端，表现为FFI较低（1.28对1.34，p = 0.0051）。所有DMRF中有21例（5.7%）被确定为DMRF（+）。与DMRF（-）相比，这些骨折脱位明显更多，且更常需要手术治疗（52.4%对24.6%，p = 0.009）。
FFI可能是识别和描述DMRF的良好工具。它有助于指导治疗决策，并使未来关于该实体的研究更具可比性。
诊断试验研究，二级。
