Tiwari A, Kanojia R K, Kapoor S K
Department of Orthopaedics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
J Orthop Surg (Hong Kong). 2007 Aug;15(2):177-82. doi: 10.1177/230949900701500211.
To report the results of surgical management for late-presenting displaced supracondylar fractures of the humerus in children.
Between February 2002 and June 2003, 40 children (mean age, 7 years) with late presentation (range, 2-12 days) of displaced supracondylar humeral fractures were prospectively recruited. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Manipulation was successful in 25 patients and percutaneous skeletal stabilisation with Kirschner wires was performed. The remaining 15 patients were treated with open reduction and Kirschner wire fixation, using a mediolateral approach.
The mean delay in presentation was approximately 4 days. No patients presenting more than 7 days after injury had the fracture reduced by closed manipulation. The mean hospital stay was 41 hours. At the final follow-up (mean, 18 months), 88% of the patients had a satisfactory result, according to Flynn's criteria.
Operative treatment for late presentation of supracondylar humeral fractures in children is effective. It minimises the risk of complications and the need for continuous traction or corrective osteotomy.
报告儿童肱骨髁上骨折延迟就诊且移位的手术治疗结果。
在2002年2月至2003年6月期间，前瞻性招募了40例（平均年龄7岁）肱骨髁上骨折延迟就诊（范围为2 - 12天）且移位的儿童。除1例开放性复合骨折患者外，所有患者均尝试在影像增强器引导下进行轻柔的闭合复位。25例患者复位成功并采用克氏针进行经皮骨骼固定。其余15例患者采用内外侧联合入路进行切开复位及克氏针固定。
平均延迟就诊时间约为4天。受伤超过7天就诊的患者，无一例通过闭合复位使骨折复位。平均住院时间为41小时。根据弗林（Flynn）标准，在末次随访时（平均18个月），88%的患者结果满意。
儿童肱骨髁上骨折延迟就诊的手术治疗是有效的。它将并发症风险以及持续牵引或截骨矫正的需求降至最低。
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