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ID: 210 (Conflict of Interest: K)

Behandlung distaler Unterarmfrakturen bei Kindern – retrospektive Analyse von 265 Patienten der Unfallkasse Sachsen

M.Lorenz, J.Schultz, P.Schwerk, G.Fitze
Universitätsklinikum Dresden, Dresden

Einleitung

Introduction: Distal forearm fractures are the most common fractures during infancy and childhood. Incidence rates peak around puberty. Due to the lack of standardized treatment protocols, pediatric surgeons and orthopedic surgeons develop different concepts to handle these fractures.

The primary objective of this study is to elicit how pediatric distal forearm fractures are treated in Saxony. We also wanted to assess the clinical outcomes of different treatment modalities.

Material und Methoden

Methods: Retrospectively, we analyzed all distal forearm fractures reported to the public accident insurance “Unfallkasse Sachsen”. We included all children 15 years or younger injured in 2012 and 2013. Initial and final values for angulation and displacement were collected; cast types, methods of operation, complication rates; complaints at the time of injury and after finishing the treatment were also recorded among various other variables.

Ergebnisse

Results

265 children were included in our analysis. The mean age was 10.2years. 29 percent (n=78) of the distal forearm fractures were metaphyseal buckle fractures. The initial treatment mostly happened in hospitals in bigger cities. Of all fractures but buckle fractures (n=187), 38% (n=71) were treated operatively. Of these patients, 57 were initially treated operatively. This was mostly due to dislocated complete metaphyseal fractures (n=30) and Aitken I fractures (n=25) while another 14 patients were operated after conservative management had failed. 82 percent of the operated children were treated with Kirschner-wires. After finishing the treatment, only 7% of the conservatively treated patients complained about functional limitations in contrast to 17% of the operated patients. Complications were reported in 22 cases, mainly due to redislocations. However, the complication rates did not differ greatly in between primarily operatively treated patients (6 out of 57) and primarily conservatively treated patients (16 out of 194). The highest complication rates were seen in primarily conservatively treated greenstick fractures (5 out of 22).

Schlussfolgerung

Conclusions: We conclude that distal forearm fractures in children are mostly treated conservatively. Clinical outcomes differ according to the treatment method chosen.