目的:肱骨髁外侧骨折占儿童肱骨远端骨折的12%~17%,通常以孤立性损伤发生或与桡骨颈和/或尺骨近端骨折相关。伴有肘部脱位的表现很少见。因此,关于这种罕见组合的年轻患者的文献很少,并且大多限于病例报告和小病例系列。本研究的目的是确定这种损伤的最佳治疗策略。认识到并发症发展的潜在危险因素,并确定结果的预测因子。
方法:这是对被诊断为肱骨外髁骨折伴肘关节脱位(ED)的骨骼未成熟患者的电子和书面医疗记录的多中心回顾性研究。记录的数据包括患者人口统计,断裂分类,位错的方向,治疗策略,工会的时间,肘部运动范围,并发症,和额外的程序。使用改进的Flynn标准来确定结果。
结果:我们确定了23例患者,这些患者在3个机构就诊,并伴有肱骨髁外侧骨折和ED。受伤时的平均年龄为8.7岁(范围:6至13岁)。从受伤到手术的中位时间为1天(四分位距:0.5,最小到最大:0至29天)。中位随访时间为24周(四分位距:16,最小至最大:4至120周)。这种损伤更常见于Weiss3型骨折的男性(79%)。在大多数情况下,脱位的方向是后内侧或后内侧。通过改良的Kocher侧向入路切开复位并用克氏针(N=12)或空心螺钉(N=9)固定是首选的治疗方法。8例(34.8%)出现并发症,包括持续弯头刚度(N=5),肘部不稳定(N=1),和缺血性坏死(N=2)。没有延迟工会的案例,骨不连,malunion,异位骨化,神经损伤,或硬件故障。与螺钉固定相比,使用铸造或克氏针固定治疗的患者肘部僵硬率显着增加(50%,25%,11%,分别,P=0.015)。根据Flynn的标准,65%的患者有良好或优秀的结果,35%有穷人。
结论:这项研究的结果表明,与ED相关的肱骨外髁骨折患儿的并发症发生率高于先前描述的。包括持续的肘部刚度,缺血性坏死,和慢性肘部不稳定,在超过三分之一的病例中导致不满意的临床结果。我们的研究结果表明,螺钉内固定,合并较短的术后固定期(2周)可能导致改善的临床结局.
方法:III级-治疗,案例系列。
OBJECTIVE: Lateral humeral condyle fractures account for 12% to 17% of all distal humerus fractures in children, and usually occur as an isolated injury or are associated with radial neck and/or proximal ulna fractures. The presentation with a concomitant dislocation of the elbow is rare. Therefore, literature on young patients with this uncommon combination is sparse and mostly limited to case reports and small case series. The aim of the present
study is to identify the best treatment strategy for this injury, recognize potential risk factors for the development of complications, and identify predictors of outcome.
METHODS: This is a multicenter retrospective review of electronic and written medical records for skeletally immature patients who were diagnosed with a lateral condyle fracture of the humerus associated with elbow dislocation (ED). Data recorded included patient demographics, fracture classification, direction of the dislocation, treatment strategy, time to union, elbow range of motion, complications, and additional procedures. The modified Flynn criteria were used to determine the outcomes.
RESULTS: We identified 23 patients who presented to 3 institutions with a concomitant lateral humeral condyle fractures and an ED. The mean age at the time of injury was 8.7 years (range: 6 to 13 y). The median time from injury to surgery was 1 day (interquartile range: 0.5, minimum to maximum: 0 to 29 d). The median follow-up was 24 weeks (interquartile range: 16, minimum to maximum: 4 to 120 wk). The injury occurred more commonly in males (79%) with Weiss type 3 fractures. The direction of the dislocation was posterior or posteromedial in most cases. Open reduction through a modified Kocher lateral approach and fixation with either Kirschner wires (N = 12) or cannulated screws (N = 9) was the preferred method of treatment. Eight patients (34.8%) developed complications, including persistent elbow stiffness (N = 5), elbow instability (N = 1), and avascular necrosis (N = 2). There were no cases of delayed union, nonunion, malunion, heterotopic ossification, neurological injury, or hardware failure. Patients treated with casting or Kirschner wire fixation had a significantly increased rate of elbow stiffness compared with screw fixation (50%, 25%, and 11%, respectively, P = 0.015). According to Flynn\'s criteria, 65% of the patients had good or excellent outcomes, and 35% had poor.
CONCLUSIONS: The findings of this
study demonstrate a higher than previously described rate of complications in children with lateral condyle humerus fracture associated with ED, including persistent elbow stiffness, avascular necrosis, and chronic elbow instability, leading to unsatisfactory clinical outcomes in over one-third of the cases. Our findings suggest that the internal fixation with screws, combined with a shorter postoperative immobilization period (2 wk) may lead to improved clinical outcomes.
METHODS: Level III-therapeutic, case series.