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小児骨折は，不全骨折となることが多い．また多少の転位がある骨折においても骨のリモデリングに期待して，保存的治療を選択することが多い．小児の上腕骨近位部骨折は比較的まれな骨折であるため，転位の許容度など不明な点が少なくない．本研究では整形外科クリニックを受診した小児の上腕骨近位部骨折の保存的治療を紹介し，小児骨折における施術のあり方について検討する．本報告では骨片転位の大きさの違いによって仮骨の出現時期や骨硬化など治癒経過に差はあるものの，最終的に骨癒合が認められた．今後も小児骨折の特徴を把握しながら，自家矯正力の限界を見極め，慎重に対応していくことが必要だと考える．, Bones of children were consistently in the growing process. When they were broken, remodeling abilities were evident. Therefore, remodeling of the fractured bones could be in their healing processes even in the cases of some displaced fractures. Because of their incomplete fractures, we often chose conservative treatment. Since the proximal part of the fracture of the humerus was seldom occurred, the amplitude of the bone chip derangement might be unknown. Children who consulted with an orthopedic clinic for the fracture of the proximal part of the humerus were rare. This study introduced the case that paid its attention to the remodeling of bones. The conservative treatment was also examined with regard to the remodeling toward the prevention of the fractures of the pediatric population in the future. Synostosis was found although there was a difference in a healing process of the callus formation or osteosclerosis.In summary, prognosis of the children’s fracture was appreciable; it might be required to provide the careful intervention until the characteristics of the pediatric fractures were well understood. Further, the intervention might have to considered the limitations of the abilities that bones remodel and develop for the complete recovery.

小児骨折は，不全骨折となることが多い．また多少の転位がある骨折においても骨のリモデリングに期待して，保存療法を選択することが多い．中でも橈骨遠位端骨折は，臨床上多く見られる骨折の一つであり，もっともリモデリングが旺盛な骨折といわれている．今回は整形外科クリニックを受診した小児の橈骨遠位端骨折について，骨のリモデリングに着目した症例を紹介し，今後の小児骨折における施術のあり方について検討する．すべての症例において，転位した骨折部がリモデリングにより受傷前の状態に復する結果となった．転位の大きさの違いによって仮骨の出現時期や骨硬化など治癒経過に差はあるものの，最終的に屈曲転位は矯正された．今回の結果により，小児の自家矯正力の高さを証明することができた．小児骨折は予後が良好な場合が多いが，自家矯正力の限界や成長障害の可能性を見極め，慎重に対応していくことが必要だと考える．, Bones of a child have a high potential to remodel themselves when they are broken. So we can expect remodeling of fractured bones in their healing processes even in the cases of some displaced fracture. In addition, child bone fractures are sometimes incomplete. Therefore, we often choose conservative treatment for cases of children’s bone fractures. Above all, the fracture of the distal radius is one of the more frequent fractures clinical and remodeling is excellent in fact.In the fracture of the distal radius of the children who consulted a clinic, we introduce the case that paid its attention to the remodeling of bones. We also examine the conservative treatment with regards to the remodeling towards a prevention of future childhood fracture.The results confirmed remodeling worked well in all cases. There was the difference in a healing process, but the flexural derangement was completely corrected. With this results, we were able to prove high autologous correction ability of the bones of children. Generally, prognosis of child bone fracture is good. However, it is necessary to treat them carefully, being aware of the limit of remodeling potency and keeping a close watch of growth disturbance to the end.

小児骨折は，不全骨折となることが多く，また 多少の骨片転位があっても骨のリモデリングに期待し，保存療法を選択することが多い．柔道整復師が取り扱うことの多い骨折の一つであり，徒手整復を行うかどうかの判断を求められる骨折でもある．しかし小児骨折における徒手整復の実態を示した調査は少ない．今回は小児骨折の実態調査をもとに，徒手整復の現状を把握し，今後の小児骨折における徒手整復の必要性について検討したいと考える．対象は2009年から2014年までの5年間に整形外科クリニックを受診した15歳以下の骨折と診断された症例とした．5年間の骨折総数は227件であった．受傷年齢は10～13歳で全体の約50％を示した．受傷原因はスポーツが49.8％で，中でもサッカーが14.5％と最も高かった．部位別では手指骨が44.5％と最も高く，前腕骨30.0％，足趾骨11.5％の順となり，上肢骨折が全体の約80％であった．症例別では橈骨遠位端部骨折が28.6％で最も高かった．当院においては，約8割が徒手整復を行わず，小児の自家矯正力を期待して保存療法を行なっていることが分かった．小児骨折の予後は良好な場合が多いが，自家矯正力の限界や成長障害の可能性を見極め，慎重に対応していくことが必要だと考える．, Bones of a child have high potential to remodel themselves in a fracture. So we can expect successful remodeling of the fractured bones in the healing processes even in the cases with some fragment dislocations. In addition, child bone fractures are sometimes incomplete. Therefore, we often choose conservative treatment in children’s cases. A bone fracture in a child is one of the fractures with which Judo therapist often handles and for which Judo therapist plays an important role in determining the treatment using the closed reduction, i.e. reposition by hand. But only a few researches were reported. In this paper, we intended to understand the current status of the child bone fractures and its therapeutic techniques and then assess the necessity of the closed reduction. Subjects were patients with fractures under the age of 15-year-old that consulted our clinic during the five years from 2009 to 2014. The number of fractures was 227. As regards injury age, cases in the age from 10 to 13-year-old account for 50% of all. Concerning causes of the injuries, 49.8% occurred in some sports, especially soccer showed the highest rate，that is 14.5% of all. Finger fractures were the most frequent, which occupied 44.5%, forearm and toe fractures did 30.0% and 11.5%, respectively. Consequently about 80% of all were the upper limb bone fractures. In detail, distal radius fractures were the most common (28.6%). Then, in order, middle, proximal and distal phalanges fractures were 18.5%, 13.7% and 8.4%, respectively. Thus the cases with any phalanx fractures were 40.6% of all. The present study has revealed that, in our clinic, we had treated about 80% of all without the closed reduction counting on the remodeling potency of the children. The rate of the fractures in which the closed reduction treatment had been used was 23.8%. Generally, prognosis of child bone fracture is good. But it is necessary to treat them carefully, being aware of limiting remodeling potency and keeping a close watch for growth disturbance to the end.