Alotaibi Muteb N, Aldaraani Lamya Ghanim A, Altala Abdulaziz S, Alqurashi Aseel A, Alateeq Ismail S, Alkhamisi Abdulkarim Abdullatif, Allehaimeed Ibrahim Saleh, Jad Ammar Yasser, Alosaimi Hamed, Alharbi Bassam H, Alenezi Ahmad, Almutairi Aliyah Zayed, Alroudhan Fares Khalid, Alqarni Mahdi Mofarah
College of Medicine, Alfaisal University, Riyadh 13523, Saudi Arabia.
Ministry of Health, Riyadh 62521, Saudi Arabia.
Medicina (Kaunas). 2025 May 6;61(5):852. doi: 10.3390/medicina61050852.
Distal radius fractures are among the most common pediatric injuries, accounting for approximately 25% of all fractures in children. Displaced fractures are prone to re-displacement, necessitating additional interventions. K-wire fixation is effective in reducing re-displacement risks, but no one has systematically assessed its use. This study aims to compare the outcomes of cast immobilization alone versus cast immobilization with K-wire fixation in pediatric patients with displaced distal radius fractures. A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Embase databases for studies comparing these treatments. The quality assessment was conducted using the Cochrane Collaboration Risk of Bias for randomized studies and the Methodological Index for non-randomized studies. The meta-analysis was carried out using RevMan software V5.4. Out of 267 initial records, 12 studies met the inclusion criteria, encompassing 1455 patients (853 treated with cast alone and 602 with K-wire fixation). Meta-analysis of 10 studies showed significantly higher re-displacement rates with cast immobilization compared to K-wire fixation (OR: 11.42, 95% CI: 2.43-53.77, = 0.002, I = 82%). The risk of secondary surgery was also higher in the cast group (OR: 6.91, 95% CI: 1.5-31.72, = 0.01, I = 75%). However, complications were lower with cast immobilization (OR: 0.68, 95% CI: 0.45-1.03, = 0.07, I = 74%), though not statistically significant. K-wire fixation appears to offer superior fracture stability and reduces the need for secondary surgeries compared to cast immobilization for displaced distal radius fractures in pediatric patients. However, both treatment modalities are associated with comparable complication rates, emphasizing the importance of individualized treatment planning.
桡骨远端骨折是儿童最常见的损伤之一，约占儿童所有骨折的25%。移位骨折容易再次移位，需要额外的干预措施。克氏针固定在降低再次移位风险方面是有效的，但尚未有人对其使用情况进行系统评估。本研究旨在比较单纯石膏固定与克氏针固定联合石膏固定在小儿桡骨远端移位骨折患者中的治疗效果。对PubMed、科学网、Cochrane CENTRAL、Scopus和Embase数据库进行全面检索，以查找比较这些治疗方法的研究。使用Cochrane协作网随机研究偏倚风险评估工具和非随机研究方法学指数进行质量评估。使用RevMan软件V5.4进行荟萃分析。在267条初始记录中，12项研究符合纳入标准，涉及1455例患者（853例仅接受石膏固定，602例接受克氏针固定）。对10项研究的荟萃分析显示，与克氏针固定相比，石膏固定的再次移位率显著更高（比值比：11.42，95%置信区间：2.43 - 53.77，P = 0.002，I² = 82%）。石膏固定组二次手术的风险也更高（比值比：6.91，95%置信区间：1.5 - 31.72，P = 0.01，I² = 75%）。然而，石膏固定的并发症较少（比值比：0.68，95%置信区间：0.45 - 1.03，P = 0.07，I² = 74%），尽管无统计学意义。与小儿桡骨远端移位骨折的石膏固定相比，克氏针固定似乎能提供更好的骨折稳定性，并减少二次手术的需求。然而，两种治疗方式的并发症发生率相当，这强调了个体化治疗计划的重要性。
