Wachstumsverhalten nach Frakturen des distalen Unterarms

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• 作者：Dr. J. Lieber (1)
  
• 关键词：Kindesalter ; Konservative Therapie ; Spontankorrektur ; Effizienz ; Kindgerechtes Therapiekonzept ; Children ; Conservative therapy ; Spontaneous correction ; Efficiency ; Therapy concepts appropriate for children
• 刊名：Der Unfallchirurg
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：117
• 期：12
• 页码：1092-1098
• 全文大小：565 KB
• 参考文献：1. Berberich T, Reimann P, Steinacher M et al (2008) Evaluation of cast wedging in a forearm fracture model. Clin Biomech 23:895-99 CrossRef
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  3. Carsi B, Abril JC, Epeldegui T (2003) Longitudinal growth after nonphyseal forearm fractures. J Pediatr Orthop 23:203-07
  4. Crawford SN, Lee LS, Izuka BH (2012) Closed treatment of overriding distal radial fractures without reduction in children. J Bone Joint Surg [Am] 94:246-52
  5. Do TT, Strub WM, Foad SL et al (2003) Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis. J Pediatr Orthop B 12:109-15
  6. Green NE, Swiontkowski MF (Hrsg) (1998) Skeletal trauma in children. Saunders, Philadelphia
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  8. Hendrickx RP, Campo MM, Van Lieshout AP et al (2011) Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature. Arch Orthop Trauma Surg 131:1663-671 CrossRef
  9. Houshian S, Holst AK, Larsen MS et al (2004) Remodeling of Salter-Harris type II epiphyseal plate injury of the distal radius. J Pediatr Orthop 24:472-76 CrossRef
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  13. Marzi I (2006) Kindertraumatologie. Steinkopff, Darmstadt
  14. Mclauchlan GJ, Cowan B, Annan IH et al (2002) Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial. J Bone Joint Surg [Br] 84:413-17
  15. Meier R, Prommersberger KJ, Van Griensven M et al (2004) Surgical correction of deformities of the distal radius due to fractures in pediatric patients. Arch Orthop Trauma Surg 124:1- CrossRef
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  17. Von Laer L (2015, in Vorbereitung) Komplikationen bei der Behandlung von Verletzungen im Wachstumsalter. In: Wirth CJ, Mutschler W, Neu J (Hrsg) Komplikationen kompakt in Orthop?die und Unfallchirurgie. Thieme, Stuttgart
  18. Von Laer L, Kraus R, Linhart W (2012) Frakturen und Luxationen im Wachstumsalter, 6.?Aufl. Thieme, Stuttgart
  19. Von Laer LR (1984) Post-traumatic growth disorders and corrective measures on the growing skeleton. Fortschr Med 102:233-35
  20. Weinberg AM, Kasten P, Castellani C et al (2001) Which axial deviation results in limitation of pro- and supination following diaphyseal lower arm fracture in childhood. Eur J Trauma 27:309-16
  21. Wilkins KE (2005) Principles of fracture remodeling in children. Injury 36(Suppl 1):A3–A11 CrossRef
  22. Zimmermann R, Gabl M, Angermann P et al (2000) Late sequelae of fractures of the distal third of the forearm during the growth period. Handchir Mikrochir Plast Chir 32:242-49 CrossRef
  
• 作者单位：Dr. J. Lieber (1)
  
  1. Abteilung für Kinderchirurgie und Kinderurologie, Universit?tskinderklinik, Hoppe-Seyler-Str. 1, 72076, Tübingen, Deutschland
  
• ISSN：1433-044X

文摘

Background The distal forearm fracture is the most common injury (40-) in pediatric traumatology. Objectives The treatment of distal forearm fractures in the growth phase contains two contrasting phenomena which are incompatible with the patient’s interests and are discussed in this article. Methods A selective literature search was carried out and selected cases are discussed. Results On the one hand there is a unique property of the juvenile skeleton with an enormous potential for spontaneous correction enabling conservative treatment for the majority of fractures. This generally leads to healing without functional or cosmetic defects, even in cases of some minor residual angulations. In contrast, high rates of overtreatment are observed, such as unnecessary or repetitive reductions and operative interventions, which are not only the result of ignorance of the growth prognosis and of correct conservative techniques but also of economic factors as a consequence of medical economization as well as positive experiences gained in adults but which cannot be transferred to children. The management of distal forearm fractures should be reserved for unstable fracture types especially in adolescent patients with limited age-dependent potential for spontaneous correction. Angulated fractures should be treated using cast wedging in order to reduce angulation to a reasonable extent. The most frequently occurring stable torus fractures require immobilization only for analgesic reasons. Intolerable angulations as well as completely dislocated fractures are treated by closed reduction and stabilized with a Kirschner wire osteosynthesis depending on age. Conclusion Treatment of distal forearm fractures should be appropriate for children as well as highly efficient, by using a minimal amount of effort. Current forms of overtreatment have to be avoided because of moral and in particular economic reasons.