JBJS：青春期前的桡骨干骺端骑跨骨折，即使短缩位石膏托外固定也不影响预后

SCIENTIFIC ARTICLE

Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents

Laaksonen, Topi MD^1,a; Kosola, Jussi MD, PhD¹; Nietosvaara, Nicolas MB¹; Puhakka, Jani MD²; Nietosvaara, Yrjänä MD, PhD^1,3; Stenroos, Antti MD, PhD¹

Author Information

The Journal of Bone and Joint Surgery: February 2, 2022 - Volume 104 - Issue 3 - p 207-214

doi: 10.2106/JBJS.21.00850

Abstract：摘要

Background: 背景

The incidence of completely displaced overriding distal metaphyseal radial fractures in children is unknown, and the optimal treatment is controversial.儿童桡骨干骺端完全移位的骑跨骨折（短缩重叠移位）的发病率尚不清楚，理想的治疗方法仍存在争议。

Methods: 方法

All completely displaced distal metaphyseal radial fractures in patients <16 years old treated in our tertiary-level institution from 2014 to 2019 were identified with use of the Kids’ Fracture Tool Helsinki. Etiology, fracture characteristics, management, and quality of treatment were assessed. telephone interview with the guardian of the patient was performed for 100 (89%) of 112 patients at 1.5 to 7.2 years (median, 4.6 years) after the injury. Pain during the last month and forearm function were recorded. Treatment satisfaction was assessed with use of a 7-point Likert scale.

从2014至2019年，用儿童骨折工具Helsinki 选定所有在我们第三级医疗机构治疗的，小于16岁的桡骨干骺端骑跨骨折。评估流行病学/骨折特征/治疗方法及疗效，电话随访112名患儿监护人中的100人，占89%，伤后随访1.5年至7.2年，平均4.6年，记录最后一次随访的疼痛及前臂功能。用Likert量表7分法评估满意度。

Results: 

A total of 113 completely displaced overriding distal metaphyseal radial fractures in 112 patients (81 of whom were residents of Helsinki) were treated during the 6-year-long study period.The mean annual incidence was 1.42 per 10,000 population.Most (73%) of these fractures occurred in children <11 years old, and most fractures were dorsally displaced and located nearly as far proximally from the distal radial physis as the maximum width of the distal metaphysis.

6年研究期间 总共治疗了112名113例完全移位桡骨远端干骺端骑跨骨折。 每1万人年发生率约1.42人。大部分（约73%）患者小于11岁，大部分骨折向背侧移位， 远端干骺端最大宽度（从骨骺线起最近端到骨干），即从骨骺线处起，以干骺端最宽处为边长画正方形，正方形区域内骨折（这一句只能勉强意译成这样，请高手修正）

Closed manipulation was attempted in two-thirds of cases in the emergency department, with a failure rate of 46%. 约三分之二的病例在急诊室试行手法闭合手法复位，失败率约46%。Strong opioids were administered in 70 of 112 patients. 112位患儿中70位用了阿片类药物。None of the 26 patients whose fractures were immobilized in an overriding position had secondary interventions, pain, or functional disability. 26位固定于重叠短缩位置的患者，没有一位需要二期手术干预，没有疼痛，没有功能障碍。The mean satisfaction with treatment on the Likert scale was 6.2. Likert量表满意度评分平均6.2

Conclusions: 

The annual incidence of overriding distal metaphyseal radial fractures patients <16 years old was shown to vary between 0.72 and 2.01 per 10,000 population. Opioids, local and general anesthesia, hospital admission, and secondary interventions can be avoided in prepubescent patients by casting these fractures in an overriding position while the patient is in the emergency department.青春前期桡骨干骺端骨折每一万人年发生率约0.72至2.01.即使急诊室予石膏托固定于重叠移位的位置，青春前期桡骨干骺端骨折患者也可以避免阿片类药物，局部麻醉或全身麻醉，住院及二期干预，

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.