Die Distale Radiusfraktur - eine Torwartverletzung bei Kindern und Jugendlichen

Distal Radius Salter-Harris III Transitional Fracture in an Adolescent Male

In contrast to the well-described Tillaux fracture of the distal tibia, transitional fractures of the distal radius are exceedingly rare and have yet to be well described. Thus far, their presence in the literature has been limited to case reports and a singular series. None have involved a Salter-Harris III fracture pattern. We present the case of a 16-year-old male who sustained a Salter-Harris III transitional fracture of the distal radius with an associated ulnar styloid avulsion fracture secondary to a fall that was treated nonoperatively. Similar to the Tillaux fracture, examination of the distal radius transitional fracture should include computed tomography scan to better illustrate the pattern of injury and guide treatment.

The treatment of upper limb fractures in children and adolescents

BACKGROUND

The treatment of fractures in children and adolescents must be based on an adequate knowledge of the physiology of the growing skeleton. Treatment failures usually do not result from technical deficiencies, but rather from a misunderstanding of the special considerations applying to the treatment of fractures in this age group.

METHODS

We selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development.

RESULTS

Alleviating pain is the first step in fracture management, and due attention must be paid to any evidence of child abuse. The goals of treatment are to bring about healing of the fracture and to preserve the function of the wounded limb. The growth that has yet to take place over the remaining period of skeletal development also has to be considered. Predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. During the period of skeletal development, conservative and surgical treatments are used in complementary fashion. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents.

CONCLUSION

The main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment (either in the hospital or on an outpatient basis) to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.

An update on the epidemiology of pediatric fractures

Despite public health measures to prevent childhood injuries, the incidence of pediatric fractures is increasing. This fracture incidence is dependent on many demographic factors, the various contributors to bone health, and an individual's risk-taking behavior. Although traditional play activities continue to be the prevalent causes for fractures, there is an evolving array of new sport and recreation activities that carry significant fracture risk. The following review article outlines the developing epidemiology of pediatric fractures by analyzing some of the individual risk factors that influence fracture incidence as well as the variety of activities that are associated with these fractures.

The epidemiology of sports-related fractures in adolescents

OBJECTIVE

To examine the epidemiology of sports-related fractures in adolescents aged 10-19 years.

METHODS

All fractures in adolescents presenting to the Royal Hospital for Sick Children and the Royal Infirmary of Edinburgh in a one-year period were prospectively documented and all sports-related fractures retrospectively examined. These two hospitals have a defined population facilitating epidemiological studies.

RESULTS

There were 408 adolescent sports-related fractures giving an overall incidence of 5.63/1000/year. The gender ratio was 87/13% male/female and 84% were upper limb fractures. Thirty sports produced 22 different fracture types. Football, rugby and skiing accounted for 66.2% of the fractures. The commonest fractures were in the finger phalanges (28.7%), distal radius and ulna (23.0%) and metacarpus (12.7%).

CONCLUSIONS

Sport-related fractures are common in adolescents, particularly in males. They tend to be low-energy injuries affecting the upper limb in particular. Few require operative treatment although their frequency means that they impose significant demands on orthopaedic surgeons and health systems.

Epidemiology of US high school sports-related fractures, 2005-2009

OBJECTIVE

To describe the epidemiology of fractures among US high school athletes participating in 9 popular sports.

DESIGN

Descriptive epidemiologic study.

SETTING

Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO).

PARTICIPANTS

A nationally representative sample of 100 US high schools.

ASSESSMENT OF RISK FACTORS

Injuries sustained as a function of sport and sex.

MAIN OUTCOME MEASURES

Fracture injury rates, body site, outcome, surgery, and mechanism.

RESULTS

Fractures (n = 568 177 nationally) accounted for 10.1% of all injuries sustained by US high school athletes. The highest rate of fractures was in football (4.61 per 10 000 athlete exposures) and the lowest in volleyball (0.52). Boys were more likely than girls to sustain a fracture in basketball (rate ratio, 1.35,; 95% confidence interval, 1.06-1.72) and soccer (rate ratio, 1.34; 95% confidence interval, 1.05-1.71). Overall, the most frequently fractured body sites were the hand/finger (28.3%), wrist (10.4%), and lower leg (9.3%). Fractures were the most common injury to the nose (76.9%), forearm (56.4%), hand/finger (41.7%), and wrist (41.6%). Most fractures resulted in >3 weeks' time lost (34.3%) or a medical disqualification from participation (24.2%) and were more likely to result in >3 weeks' time lost and medical disqualification than all other injuries combined. Fractures frequently required expensive medical diagnostic imaging examinations such as x-ray, computed tomographic scan, and magnetic resonance imaging. Additionally, 16.1% of fractures required surgical treatment, accounting for 26.9% of all injuries requiring surgery. Illegal activity was noted in 9.3% of all fractures with the highest proportion of fractures related to illegal activity in girls' soccer (27.9%).

CONCLUSIONS

Fractures are a major concern for US high school athletes. They can severely affect the athlete's ability to continue sports participation and can impose substantial medical costs on the injured athletes' families. Targeted, evidence-based, effective fracture prevention programs are needed.