目的:青年患者肱骨髁内侧骨折易被忽视。这可能导致延迟或不正确的诊断,导致治疗延迟,这通常与不愈合等并发症有关,骨坏死,鱼尾畸形,和肘内翻。这项研究的目的是评估一组因未经治疗的MHC骨折而接受延迟手术的儿科患者的临床和影像学结果。
方法:从2017年1月至2022年12月,我们对接受MHC骨折延迟治疗的儿科患者进行了回顾性研究。在所有情况下,最初的诊断不正确,受伤后至少一周进行了手术.根据创伤和手术之间的时间将患者分为两组:第1组由受伤后7至30天内接受早期延迟治疗的个体组成,而第2组包括受伤后一个月以上接受延迟治疗的患者。使用Mayo肘关节性能评分(MEPS)和活动范围(ROM)评估肘关节功能。还回顾了相关文献(1970-2023年)。
结果:我们招募了12名患者(7名男孩,5名女孩);手术时的平均年龄为7.7岁(范围,2-14年)。六名患者接受了早期延迟治疗(第1组),而另外六名患者接受了晚期延迟治疗(第2组)。从受伤到手术的平均时间为17.7天(范围,7-30天)和33.3个月(范围,第1组和第2组分别为70天-9年)。11例患者通过内侧入路进行了切开复位内固定,1例患者行闭合楔形截骨术和内固定术以矫正肘内翻畸形。平均随访时间为39.4个月(范围,8-60个月)。第1组的平均MEPS评分为98.3(范围,95-100)和第2组中的94.2(范围,85-100;P=0.21)。记录以下术后并发症:异位骨化(n=2),鱼尾畸形(n=1),MHC坏死(n=1),肘部ROM减少(n=1);第1组发生1例并发症,第2组发生5例并发症(P=0.18)。我们回顾了9项相关研究(n=14例患者)。
结论:在儿科患者中,MHC骨折的诊断可能具有挑战性,尤其是在滑车不完全骨化的年轻人中。需要手术治疗未骨化滑车的延迟性MHC骨折的患者应接受ORIF治疗,以防止进行性内翻畸形。另一方面,在肘内翻和已经骨化的滑车患者中,应考虑肱骨远端截骨术,而不是ORIF。这将最小化对关节移动性的潜在负面影响。
OBJECTIVE: Medial humeral condyle (MHC) fractures are easily overlooked in young patients. This can lead to delayed or incorrect diagnosis, resulting in delayed treatment, which is often associated with complications such as nonunion, osteonecrosis, fishtail deformity, and cubitus varus. The purpose of this study is to evaluate the clinical and radiographic outcomes in a cohort of paediatric patients who underwent delayed surgery for an untreated MHC fracture.
METHODS: From January 2017 to December 2022, we conducted a retrospective study of paediatric patients who underwent delayed treatment for a MHC fracture. In all cases, the initial diagnosis was incorrect and surgery was performed at least one week after injury. Patients were divided into two groups based on the time between trauma and surgery: Group 1 consisted of individuals who underwent early delayed treatment within seven to 30 days of injury, while Group 2 consisted of those who underwent late delayed treatment more than one month after injury. Elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM). The related literature was also reviewed (1970-2023).
RESULTS: We enrolled 12 patients (7 boys, 5 girls); the average age at the time of surgery was 7.7 years (range, 2-14 years). Six patients underwent early delayed treatment (Group 1) while another six underwent late delayed treatment (Group 2). The mean time from injury to surgery was 17.7 days (range, 7-30 days) and 33.3 months (range, 70 days-9 years) in Groups 1 and 2, respectively. Open reduction and internal fixation were performed via a medial approach in 11 patients, while one patient underwent closing wedge osteotomy and internal fixation to correct cubitus varus deformity. The mean duration of follow-up was 39.4 months (range, 8-60 months). The average MEPS score was 98.3 in Group 1 (range, 95-100) and 94.2 in Group 2 (range, 85-100; P = 0.21). The following postoperative complications were recorded: heterotopic ossification (n = 2), fishtail deformity (n = 1), MHC necrosis (n = 1), and reduction of elbow ROM (n = 1); one complication occurred in Group 1 and five occurred in Group 2 (P = 0.18). We reviewed nine related studies (n = 14 patients).
CONCLUSIONS: Diagnosis of MHC fractures can be challenging in paediatric patients, especially in younger individuals with incompletely ossified trochlea. Patients requiring surgery for delayed MHC fractures with an unossified trochlea should undergo ORIF to prevent progressive varus deformity. On the other hand, in patients with cubitus varus and an already ossified trochlea, distal humeral osteotomy should be considered instead of ORIF. This will minimize the potential negative impact on joint mobility.