Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-24 DOI:10.1097/BPO.0000000000002853

Stephen Chen, Matthew E LaBarge, Abigail L Henry, Jacquelyn Pennings, Jeffrey E Martus

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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 of evidence: Level III-retrospective comparative study.

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老年儿童和青少年的前臂骨折：ORIF比IMN更安全，疗效相当。

背景：需要进一步了解骨骼成熟度对治疗效果的影响，以指导儿童和青少年前臂骺骨折的手术治疗。本研究旨在比较采用髓内钉（IMN）或切开复位内固定（ORIF）治疗的儿童前臂骺端骨折的并发症和疗效，并确定骨骼成熟度的影像学标志，以帮助选择治疗方案：方法：对接受手术治疗的 10-16 岁前臂骺端骨折患者进行回顾性研究。骨骼成熟度的指标包括骨骺评分、是否存在拇指内收骨和桡骨骨骺盖。并发症采用改良的 Clavien-Dindo 系统进行分级。结果根据最终的术后活动范围和并发症等级进行评分：结果：共纳入 260 名患者：结果：共纳入 260 例患者：163 例采用 IMN 治疗，97 例采用 ORIF 治疗，平均年龄 12.7 岁，72% 为男性。在接受IMN治疗的闭合性前臂骨折患者中，45%（53/118）需要切开复位。接受IMN治疗的患者的并发症发生率高于接受ORIF治疗的患者（27.0%对9.3%，PConclusions）：在所有年龄组和骨骼成熟度的患者中，ORIF的并发症发生率明显低于IMN，且治疗效果相当。与年龄较大的患者相比，骨骼更不成熟的患者接受 ORIF 治疗的效果明显更好。拇指内收骨节、桡骨骨骺盖和骨骺评分并不能提供有用的信息，在这一人群中选择ORIF还是IMN：证据级别：III级--回顾性比较研究。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.