Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?

IF 1.3 4区医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-08-01 DOI:10.1177/18632521231182420

Nakul S Talathi, Brendan Shi, Jeremy Policht, Bailey Mooney, Kevin Y Chen, Mauricio Silva, Rachel M Thompson

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Abstract

Introduction: Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction.

Methods: We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups.

Results: A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis.

Conclusion: Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population.

Level of evidence: level III Case Control Study.

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儿童前臂骨折非手术治疗失败的可改变和不可改变的危险因素:我们在哪些方面可以做得更好?

第三前臂远端骨折是儿童常见的骨折。虽然结果通常很好，但一些患者最初的非手术治疗失败，需要干预。本研究的目的是确定与闭合复位失败相关的独立危险因素。方法:我们对儿童第三前臂远端骨折采用闭合复位铸造治疗的病例进行回顾性分析。患者被分为两组，一组成功闭合复位，另一组失败的初始非手术治疗。统计学特征、铸造类型、铸造指数、x线骨折、软组织特征和复位质量进行分析。结果:共有207例儿童前臂远端第三骨折纳入分析。共有190例(91.8%)患儿保持了下降，17例(8.2%)患儿首次非手术治疗失败。单变量分析显示，与复位损失相关的可变危险因素包括使用长臂石膏(p = 0.003)、复位后移位增加(p = 0.02)和复位后角度畸形增加(p = 0.01)。不可改变的危险因素包括体重指数增加(p = 0.02)，骨折移位增加(p = 0.002)，骨折部位软组织包膜宽度增加(p = 0.0001)。在多因素分析后，使用长臂石膏(13% vs 2%，优势比= 6.44)和软组织宽度(60.6 vs 50.4 mm，优势比= 1.1)仍然是减少损失的重要危险因素。结论:在儿童人群中，骨折部位较大的软组织包膜和长臂石膏固定与第3前臂远端骨折初始闭合复位失败的风险增加独立相关。证据等级:III级病例对照研究。

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来源期刊

Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine

CiteScore

2.70

自引率

14.30%

发文量

审稿时长

23 weeks

期刊介绍： Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.