Farsetti P, Potenza V, Caterini R, Ippolito E
Department of Orthopaedic Surgery, University of Rome, La Sapienza, Italy.
J Bone Joint Surg Am. 2001 Sep;83(9):1299-305. doi: 10.2106/00004623-200109000-00001.
The treatment of isolated, displaced fractures of the medial humeral epicondyle in children is controversial. Both plaster cast immobilization without reduction and open reduction and internal fixation have been advocated. The purpose of this long-term retrospective study was to analyze the functional and radiographic results of both nonsurgical and surgical management of these injuries.
Forty-two patients who had had an isolated fracture of the medial humeral epicondyle with displacement of >5 mm at an average age of twelve years (range, eight to fifteen years) were evaluated at an average age of forty-five years (range, thirty to sixty-one years). The patients were divided into three groups that were comparable with regard to the amount of fracture displacement, age at the time of the fracture, age at the time of follow-up, sports activities and occupation, and duration of follow-up. In Group I (nineteen patients), the fracture had been treated with a long-arm plaster cast without reduction of the displaced medial epicondyle. In Group II (seventeen patients), open reduction and internal fixation with either Kirschner wires or a T-nail had been performed. In Group III (six patients), the epicondylar fragment had been excised with suture reattachment of the tendons and the medial collateral ligament.
According to a functional grading scale, there were sixteen good and three fair results in Group I. All but two patients were seen to have nonunion of the fragment on follow-up radiographs, but all had a normal result on valgus stress-testing of the elbow. The range of motion of the elbow was either normal or minimally decreased, and the grip strength of the ipsilateral hand was normal. There were fifteen good and two fair results in Group II. All patients had union of the medial epicondyle, with various radiographic deformities of the medial epicondyle, but the functional results were similar to those of the Group-I patients. The Group-III patients had four poor and two fair results. Four had constant pain at the elbow and paresthesias in the distribution of the ulnar nerve. One patient had a restricted range of motion of the elbow, four patients had an unstable elbow, and three patients had decreased grip strength of the ipsilateral hand.
In our study, nonsurgical treatment of isolated fractures of the medial humeral epicondyle with between 5 and 15 mm of displacement yielded good long-term results similar to those obtained with open reduction and internal fixation. The nonunion of the epicondylar fragment that was present in most patients who had been treated only with a cast did not adversely affect the functional results. Surgical excision of the medial epicondylar fragment should be avoided because the long-term results are poor.
儿童肱骨内上髁孤立性移位骨折的治疗存在争议。不进行复位的石膏固定以及切开复位内固定均有人主张。这项长期回顾性研究的目的是分析这些损伤非手术和手术治疗的功能及影像学结果。
对42例平均年龄12岁（范围8至15岁）的肱骨内上髁孤立性骨折且移位>5mm的患者，在平均年龄45岁（范围30至61岁）时进行评估。患者被分为三组，在骨折移位程度、骨折时年龄、随访时年龄、体育活动及职业、随访时长方面具有可比性。第一组（19例患者），骨折采用长臂石膏固定，未对移位的内上髁进行复位。第二组（17例患者），采用克氏针或T形钉进行切开复位内固定。第三组（6例患者），切除髁上碎片，并对肌腱和内侧副韧带进行缝合重新附着。
根据功能分级量表，第一组有16例优和3例良的结果。除2例患者外，随访X线片显示所有患者碎片均未愈合，但所有患者肘关节外翻应力试验结果正常。肘关节活动范围正常或轻微减小，患侧手握力正常。第二组有15例优和2例良的结果。所有患者内上髁均愈合，内上髁存在各种影像学畸形，但功能结果与第一组患者相似。第三组患者有4例差和2例良的结果。4例患者肘部持续疼痛，尺神经分布区有感觉异常。1例患者肘关节活动范围受限，4例患者肘关节不稳定，3例患者患侧手握力下降。
在我们的研究中，移位5至15mm的肱骨内上髁孤立性骨折的非手术治疗产生了与切开复位内固定相似的良好长期结果。大多数仅接受石膏固定治疗的患者中存在的髁上碎片未愈合并未对功能结果产生不利影响。应避免手术切除内侧髁上碎片，因为长期结果较差。
