背景:肱骨外髁骨折是儿童肘部最常见的第二骨折。然而,肘关节脱位是一个罕见的实体。因此,关于这种罕见组合的年轻患者的文献很少。我们旨在对与肘关节脱位相关的小儿肱骨外髁骨折的文献进行系统回顾。
方法:在1960年至2020年之间对PubMed和Embase数据库进行了系统回顾,以获取同行评审的文献。两名审阅者过滤了结果,寻找英语和西班牙语的文章,报道了肱骨外髁骨折与肘关节脱位相关的骨骼未成熟患者。结果包括患者和受伤特征,治疗策略,并发症,和最终结果,包括运动范围。
结果:最初的搜索共产生了851项研究。经过初步筛选,包括16项研究,67名患者可供复查。受伤时报告的年龄为2至12岁。病变更常见于男性(60%)患有MilchII,和Jakob3型骨折.在大多数情况下,脱位的方向是后内侧。通过侧向入路和克氏针放置切开复位是最有效的治疗方法。报告的随访时间为3至156个月。14项研究报告了1/3患者的并发症,包括:活动范围有限,肘内翻,不稳定性,硬件突出,延迟工会,骨不连,malunion,异位骨化,神经损伤,硬件故障。13项研究报告了临床结果,在10例患者中,有2例被评为一般或较差。
结论:目前的证据是IV级,表明在肘关节脱位相关的情况下,外侧髁骨折手术治疗后的并发症发生率很高。次优结果的百分比升高。本系列中最常见的并发症是肘部僵硬和肘内翻。
BACKGROUND: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic
review of the literature searching for paediatric lateral condyle humerus fractures associated to elbow dislocation.
METHODS: A systematic
review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion.
RESULTS: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for
review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2 out of 10 patients.
CONCLUSIONS: Current evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.