Ludwig Todd, Campbell Megan L, Grothaus Olivia, Sato Eleanor H, Presson Angela P, Zhang Chong, Holmes Stephanie, Klatt Joshua
University of Utah Department of Orthopaedics, Salt Lake City, UT.
University of Utah Division of Epidemiology, Salt Lake City, UT.
J Pediatr Soc North Am. 2024 Feb 12;5(1):597. doi: 10.55275/JPOSNA-2023-597. eCollection 2023 Feb.
Various techniques of non-operative management of pediatric forearm fractures have proven to be successful in avoiding surgical risk and obtaining acceptable outcomes for patients. However, the ability of plaster versus fiberglass splint material to maintain reduction of these fractures has not been compared. Our goal was to determine whether splint material affects the success of non-operative management of pediatric forearm fractures. All patients aged 0-18 years with a traumatic forearm fracture requiring reduction were enrolled prospectively and randomized to fiberglass (Ortho-Glass®, Essity Medical Solutions, Charlotte, NC) or plaster sugartong splints. A total of 230 patients met inclusion criteria: 90 randomized to plaster and 140 to fiberglass. Patients were stratified based on location of fracture: distal radius fractures (DRF), middle both bone forearm fractures (BBFFx), and proximal BBFFx. Radiographic outcomes including residual deformity and clinical outcomes including conversion to surgery were evaluated in all patients. Statistical analysis was performed with t-test, Wilcoxon rank sum, Chi-Square, or Fisher's exact tests where applicable. Radiographic and clinical outcomes were similar between fiberglass and plaster splints. Overall, only 2.6% of patients required conversion to surgery, 1.1% of the plaster cohort and 3.6% of the fiberglass cohort (p=0.41). No patients required re-reduction with sedation. At final follow-up, 32.5% of middle or proximal BBFFx and 1.3% of DRF healed in "unacceptable" alignment according to classically described guidelines. There is no difference in the effectiveness of fiberglass or plaster sugartong splints for initial immobilization of pediatric BBFFx and DRF. Rates of conversion to surgery were lower in both groups than previously described. However, there was a trend toward treating "unacceptably" aligned forearm fractures non-operatively and more research is indicated to determine the long-term clinical significance. Level I •Splint material is not a contributing factor to maintaining reduction of distal radius and both bone forearm fractures in children.•Closed reduction and sugartong splinting of pediatric distal radius and both bone forearm fractures provide favorable outcomes with low surgical conversion rate.
各种小儿前臂骨折的非手术治疗技术已被证明在避免手术风险并为患者取得可接受的治疗效果方面是成功的。然而，石膏夹板与玻璃纤维夹板材料在维持这些骨折复位方面的能力尚未得到比较。我们的目标是确定夹板材料是否会影响小儿前臂骨折非手术治疗的成功率。所有年龄在0至18岁、因外伤性前臂骨折需要复位的患者均被前瞻性纳入研究，并随机分为玻璃纤维组（Ortho-Glass®，Essity Medical Solutions，夏洛特，北卡罗来纳州）或石膏糖钳夹板组。共有230名患者符合纳入标准：90名随机分配至石膏组，140名随机分配至玻璃纤维组。患者根据骨折部位进行分层：桡骨远端骨折（DRF）、双骨前臂中段骨折（BBFFx）和双骨前臂近端骨折。对所有患者评估包括残余畸形的影像学结果以及包括转为手术治疗的临床结果。在适用的情况下，使用t检验、Wilcoxon秩和检验、卡方检验或Fisher精确检验进行统计分析。玻璃纤维夹板和石膏夹板的影像学和临床结果相似。总体而言，只有2.6%的患者需要转为手术治疗，石膏组为1.1%，玻璃纤维组为3.6%（p = 0.41）。没有患者需要在镇静下再次复位。在最终随访时，根据经典描述的指南，32.5%的双骨前臂中段或近端骨折以及1.3%的桡骨远端骨折在“不可接受”的对线情况下愈合。玻璃纤维或石膏糖钳夹板在小儿双骨前臂骨折和桡骨远端骨折的初始固定效果上没有差异。两组的手术转换率均低于先前描述的水平。然而，对于“不可接受”对线的前臂骨折进行非手术治疗存在一种趋势，需要更多研究来确定其长期临床意义。一级证据 •夹板材料不是维持儿童桡骨远端和双骨前臂骨折复位的影响因素。•小儿桡骨远端和双骨前臂骨折的闭合复位及糖钳夹板固定可提供良好的治疗效果，手术转换率低。
