D. Ravier, I. Morelli, V. Buscarino, C. Mattiuz, L. Sconfienza, Andrea Spreafico, G. Peretti, D. Curci
{"title":"儿童前臂远端骨折的石膏石膏治疗:哪个指标最能预测复位损失?","authors":"D. Ravier, I. Morelli, V. Buscarino, C. Mattiuz, L. Sconfienza, Andrea Spreafico, G. Peretti, D. Curci","doi":"10.1097/BPB.0000000000000678","DOIUrl":null,"url":null,"abstract":"Several radiological indices were introduced to evaluate cast adequacy for paediatric distal forearm fractures: cast, gap, padding, Canterbury (reflecting the cast shape and the amount of padding) and three-point indices, and second metacarpal-radius angle (measuring cast ulnar-moulding). The aim of this study is to define which index is most reliable in assessing cast adequacy and predicting redisplacements. Hundred twenty-four consecutive patients (age 5–18) affected by distal both-bone forearm or radius fractures treated with casting were included. These indices and the displacement angles were calculated on the initial radiograph after reduction. Radiographs at 7 and 30 days were taken to assess if the loss of reduction occurred, and measure the displacement deltas (displacement angle at day 30 – displacement angle at day 0). Student’s t-test, Chi-square test and Pearson’s correlation were used for the statistical analysis. High padding (P = 0.034), Canterbury (P = 0.002) and Cast (P < 0.001) indices showed an association with redisplacements in distal forearm fractures. Both-bone forearm fractures have a higher risk of loss of reduction than radius fractures [odds ratio (OR = 4.99, 95% confidence interval (CI) = 2.21–11.3, P < 0.001]. A higher displacement delta in antero-posterior (Pearson’s r = 0.418, P = 0.037) and lateral (P = 0.045) views for both-bone fractures showed an association with a high gap Index. Regarding radius fractures, a high cast index is associated with a higher displacement delta in antero-posterior (P = 0.035). The three-point index and the second metacarpal-radius angle did not show any association with the redisplacement risk. Cast oval moulding without excessive padding may prevent redisplacements in paediatric distal forearm fractures, while casts ulnar-moulding does not.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"266 1","pages":"179 - 186"},"PeriodicalIF":0.0000,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"Plaster cast treatment for distal forearm fractures in children: which index best predicts the loss of reduction?\",\"authors\":\"D. Ravier, I. Morelli, V. Buscarino, C. Mattiuz, L. Sconfienza, Andrea Spreafico, G. Peretti, D. Curci\",\"doi\":\"10.1097/BPB.0000000000000678\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Several radiological indices were introduced to evaluate cast adequacy for paediatric distal forearm fractures: cast, gap, padding, Canterbury (reflecting the cast shape and the amount of padding) and three-point indices, and second metacarpal-radius angle (measuring cast ulnar-moulding). The aim of this study is to define which index is most reliable in assessing cast adequacy and predicting redisplacements. Hundred twenty-four consecutive patients (age 5–18) affected by distal both-bone forearm or radius fractures treated with casting were included. These indices and the displacement angles were calculated on the initial radiograph after reduction. Radiographs at 7 and 30 days were taken to assess if the loss of reduction occurred, and measure the displacement deltas (displacement angle at day 30 – displacement angle at day 0). Student’s t-test, Chi-square test and Pearson’s correlation were used for the statistical analysis. High padding (P = 0.034), Canterbury (P = 0.002) and Cast (P < 0.001) indices showed an association with redisplacements in distal forearm fractures. Both-bone forearm fractures have a higher risk of loss of reduction than radius fractures [odds ratio (OR = 4.99, 95% confidence interval (CI) = 2.21–11.3, P < 0.001]. A higher displacement delta in antero-posterior (Pearson’s r = 0.418, P = 0.037) and lateral (P = 0.045) views for both-bone fractures showed an association with a high gap Index. Regarding radius fractures, a high cast index is associated with a higher displacement delta in antero-posterior (P = 0.035). The three-point index and the second metacarpal-radius angle did not show any association with the redisplacement risk. 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引用次数: 3
摘要
介绍了几种放射学指标来评估小儿前臂远端骨折的铸造充分性:铸件、间隙、填充物、坎特伯雷(反映铸件形状和填充物的数量)和三点指标,以及第二掌桡骨角(测量铸造尺骨塑形)。本研究的目的是确定哪个指标是最可靠的评估铸造充分性和预测再移位。连续纳入124例(5-18岁)用铸造治疗的前臂或桡骨远端骨折患者。这些指标和位移角在复位后的初始x线片上计算。第7天和第30天的x线片评估复位是否丢失,并测量位移delta(第30天的位移角-第0天的位移角)。采用学生t检验、卡方检验和Pearson相关性进行统计分析。高填充指数(P = 0.034)、Canterbury指数(P = 0.002)和Cast指数(P < 0.001)与前臂远端骨折再移位有关。前臂双骨骨折失去复位的风险高于桡骨骨折[优势比(OR = 4.99, 95%可信区间(CI) = 2.21-11.3, P < 0.001]。双侧骨折前后位(Pearson’s r = 0.418, P = 0.037)和侧位(P = 0.045)较高的位移delta与高间隙指数相关。对于桡骨骨折,较高的铸型指数与较高的前后移位δ相关(P = 0.035)。三点指数和第二掌骨桡骨角与再移位风险没有任何关联。没有过多填充物的铸型椭圆形模塑可以防止小儿前臂远端骨折的再移位,而铸型尺骨模塑则没有。
Plaster cast treatment for distal forearm fractures in children: which index best predicts the loss of reduction?
Several radiological indices were introduced to evaluate cast adequacy for paediatric distal forearm fractures: cast, gap, padding, Canterbury (reflecting the cast shape and the amount of padding) and three-point indices, and second metacarpal-radius angle (measuring cast ulnar-moulding). The aim of this study is to define which index is most reliable in assessing cast adequacy and predicting redisplacements. Hundred twenty-four consecutive patients (age 5–18) affected by distal both-bone forearm or radius fractures treated with casting were included. These indices and the displacement angles were calculated on the initial radiograph after reduction. Radiographs at 7 and 30 days were taken to assess if the loss of reduction occurred, and measure the displacement deltas (displacement angle at day 30 – displacement angle at day 0). Student’s t-test, Chi-square test and Pearson’s correlation were used for the statistical analysis. High padding (P = 0.034), Canterbury (P = 0.002) and Cast (P < 0.001) indices showed an association with redisplacements in distal forearm fractures. Both-bone forearm fractures have a higher risk of loss of reduction than radius fractures [odds ratio (OR = 4.99, 95% confidence interval (CI) = 2.21–11.3, P < 0.001]. A higher displacement delta in antero-posterior (Pearson’s r = 0.418, P = 0.037) and lateral (P = 0.045) views for both-bone fractures showed an association with a high gap Index. Regarding radius fractures, a high cast index is associated with a higher displacement delta in antero-posterior (P = 0.035). The three-point index and the second metacarpal-radius angle did not show any association with the redisplacement risk. Cast oval moulding without excessive padding may prevent redisplacements in paediatric distal forearm fractures, while casts ulnar-moulding does not.