Paediatric forearm fractures are extremely common among children. Surgical treatment instead of casting is necessitated in highly unstable forearm fractures. A widely accepted technique of operative fixation today is via the elastic stable intramedullary nail (ESIN), which was first introduced in 1977. Closed reduction with the ESIN is often attempted first, failure of which may warrant the need for open reduction. However, multiple attempts at closed reduction not only increase the incidence of tissue trauma but also lead to severe postoperative complications such as compartment syndrome. Yet, little information exists to help surgeons anticipate when a child is more likely to require an open reduction. This study aims to determine certain risk factors that would point toward a greater likelihood of open reduction, and thus help surgeons avoid too many unnecessary endeavors at closed reduction. A total of 144 cases of forearm fractures fixated using ESINs between 2014 and 2019 were retrospectively identified in the institution of study. Patient factors, fracture characteristics and surgery details were also gathered from the institution’s database. Statistical analysis was performed using SPSS and comparison was then done between the two groups of patients who underwent closed and open reductions. Results showed that the statistically significant risk factors for predicting unsuccessful closed reduction in forearm fractures were the amount of fractured bone overlap at presentation (P < 0.001) and whether the bones were fractured at different levels (P = 0.032). Other variables examined, including the patient’s biological age, skeletal age, BMI, fractured bone-angulation, site of fracture, fracture pattern and surgical circumstances did not contribute to differentiating between the likelihood of a closed versus open reduction. Children with a higher degree of fractured bone overlap at presentation or if the radius and ulnar bones were fractured at different levels, should be adequately forewarned regarding the increased chances of conversion to an open reduction. Surgeons should also avoid excessive attempts at closed reduction of forearm fractures with the ESIN in such circumstances.

Level of Evidence: 

Level IV.

中文翻译：

---

回顾性分析：弹性稳定髓内钉（ESIN）治疗儿童前臂骨干骨折闭合复位失败的危险因素

儿童前臂骨折在儿童中极为常见。对于高度不稳定的前臂骨折，需要手术治疗而不是石膏治疗。如今，一种广泛接受的手术固定技术是通过弹性稳定髓内钉 (ESIN) 进行固定，该技术于 1977 年首次推出。通常首先尝试使用 ESIN 进行闭合复位，如果失败，可能需要进行切开复位。然而多次尝试闭合复位不仅会增加组织创伤的发生率，还会导致骨筋膜室综合征等严重的术后并发症。然而，很少有信息可以帮助外科医生预测孩子何时更有可能需要切开复位术。这项研究旨在确定某些风险因素，这些因素会导致切开复位的可能性更大，从而帮助外科医生避免在闭合复位时进行过多不必要的努力。研究机构回顾性分析了 2014 年至 2019 年间使用 ESIN 固定的 144 例前臂骨折病例。患者因素、骨折特征和手术细节也从该机构的数据库中收集。使用SPSS进行统计分析，然后对两组接受闭合复位和切开复位的患者进行比较。结果显示，预测前臂骨折闭合复位失败的具有统计学意义的危险因素是就诊时骨折骨重叠量（P < 0.001）和骨折是否发生不同程度的骨折（P = 0.032）。检查的其他变量，包括患者的生物年龄、骨龄、体重指数、骨折角度、骨折部位、骨折模式和手术环境，并不能帮助区分闭合复位与开放复位的可能性。对于就诊时骨折骨重叠程度较高的儿童，或者如果桡骨和尺骨发生不同程度的骨折，应充分警告儿童转切开复位的机会增加。在这种情况下，外科医生还应避免过度尝试使用 ESIN 闭合复位前臂骨折。

证据级别： 

四级。