Simanovsky Naum, Lamdan Ron, Mosheiff Rami, Simanovsky Natalia
Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University Medical School, Jerusalem, Israel.
J Pediatr Orthop. 2007 Oct-Nov;27(7):733-8. doi: 10.1097/BPO.0b013e3181558a63.
Although supracondylar fractures of the humerus in children are common, the literature is sparse regarding acceptable limits of reduction of these fractures in the sagittal plane.
We retrospectively reviewed 223 pediatric cases of supracondylar fractures of the elbow treated in our hospital between the years 1996 and 2000.
In 30 patients, we found some degree of underreduction of the extension component of the fracture. Twenty-two of them were followed and evaluated at or close to skeletal maturity. The mean age at the time of fracture was 5.4 years, the mean follow-up was 8.2 years. Radiographic remodeling, range of elbow motion, and awareness of the patients to the functional limitation were evaluated. At final follow-up, 17 (77%) of the patients had radiographic abnormality of the humerocondylar angle (a difference of 5 degrees or more compared with the uninjured side). Eleven patients (50%) had limited elbow flexion, and 7 (31%) were aware of this deficit. Most of the underreductions occurred when reduction was attempted in the emergency department, when the angulation was not appreciated, and when the cast was applied without any reduction attempt. Patients who were left to heal with some degree of extension developed limited end-elbow flexion and were aware of it. Although only 3 patients felt minor subjective functional disability at the last follow-up, 10 patients had unsatisfactory results according to Flynn criteria for motion restriction.
The treating surgeon must be aware of this possible outcome and be more demanding in the reduction of the extension component of the fracture. Otherwise, clinically significant limitation in elbow flexion may occur. Although the reduction of moderately displaced fractures may seem simple, it should be performed under general anesthesia and with radiographic control of reduction and pin placement.
尽管儿童肱骨髁上骨折很常见，但关于这些骨折矢状面复位可接受限度的文献却很少。
我们回顾性分析了1996年至2000年间在我院治疗的223例小儿肘部髁上骨折病例。
在30例患者中，我们发现骨折的伸展部分存在一定程度的复位不足。其中22例在骨骼成熟时或接近骨骼成熟时接受了随访和评估。骨折时的平均年龄为5.4岁，平均随访时间为8.2年。评估了影像学重塑、肘关节活动范围以及患者对功能受限的认知情况。在最终随访时，17例（77%）患者的肱骨髁角存在影像学异常（与未受伤侧相比相差5度或更多）。11例患者（50%）肘关节屈曲受限，7例（31%）意识到了这一缺陷。大多数复位不足发生在急诊科尝试复位时，当时未认识到成角情况，且在未尝试任何复位的情况下就应用了石膏。骨折伴有一定程度伸展而自行愈合的患者出现了有限的终末肘关节屈曲并意识到了这一点。尽管在最后随访时只有3例患者感觉有轻微的主观功能残疾，但根据弗林运动受限标准，10例患者的结果并不理想。
治疗外科医生必须意识到这种可能的结果，并且在骨折伸展部分的复位上要求更高。否则，可能会出现临床上明显的肘关节屈曲受限。尽管中度移位骨折的复位看似简单，但应在全身麻醉下进行，并在影像学监测下进行复位和克氏针固定。
