Hausman Michael R, Qureshi Sheeraz, Goldstein Rachel, Langford Joshua, Klug Raymond A, Radomisli Timothy E, Parsons Bradford O
Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Pediatr Orthop. 2007 Oct-Nov;27(7):739-42. doi: 10.1097/BPO.0b013e3181558ac5.
Pediatric lateral humeral condyle fractures are common injuries. Current treatment recommendations include nonoperative treatment for nondisplaced Milch type 1 fractures; however, truly nondisplaced fractures may be rare. Although closed reduction and percutaneous pinning under arthrographic visualization are most commonly used, anatomical reconstitution of the articular surface may require a lateral Kocher approach. This approach may compromise the vascularity of the distal fragment. To avoid this catastrophic complication while still obtaining anatomical articular surface reduction, we have investigated a new technique in which the lateral condyle fracture is reduced arthroscopically, allowing visualization of the articular surface without the soft tissue dissection required with open approaches. The fracture is then percutaneously pinned and immobilized as previously recommended.
Six skeletally immature patients with lateral humeral condyle fractures underwent arthroscopic reduction and percutaneous pinning. The mean age of the patients was 48 months (range, 21-69 months). There were 2 girls and 4 boys. Surgery was performed on 4 left and 2 right elbows. The mean follow-up was 32 weeks (range, 21-44 weeks). Postoperatively, all patients were placed in a long arm cast for 4 weeks. Pins and casts were removed at 4 weeks, and motion was begun. Elbow radiographs were evaluated for fracture healing, articular congruity, malunion, growth disturbance, and presence of avascular necrosis. Range of motion, function, pain, and cosmetic deformity were recorded.
All patients had full active and passive range of motion. There was no difference in range of motion compared with the contralateral side (P < 0.05). All fractures healed radiographically by 4 weeks. There were no cases of nonunion or malunion. No patients developed cubitus varus. One patient developed radiolucency of the capitellum. There were no other complications.
Arthroscopic reduction and percutaneous fixation of pediatric lateral humeral condyle fractures may offer a safe and effective alternative to open treatment with decreased soft tissue stripping and a possibly decreased risk of malunion or avascular necrosis.
Level IV.
小儿肱骨外侧髁骨折是常见的损伤。目前的治疗建议包括对无移位的米尔奇1型骨折进行非手术治疗；然而，真正无移位的骨折可能很少见。尽管在关节造影可视化下进行闭合复位和经皮穿针是最常用的方法，但关节面的解剖重建可能需要采用外侧 Kocher 入路。这种入路可能会损害远端骨折块的血运。为了避免这种灾难性并发症，同时仍能实现关节面的解剖复位，我们研究了一种新技术，即通过关节镜对肱骨外侧髁骨折进行复位，这样无需开放手术所需的软组织解剖就能观察关节面。然后按照先前的建议对骨折进行经皮穿针固定并制动。
6例骨骼未成熟的肱骨外侧髁骨折患者接受了关节镜下复位和经皮穿针治疗。患者的平均年龄为48个月（范围21 - 69个月）。其中有2名女孩和4名男孩。手术在4例左侧和2例右侧肘部进行。平均随访时间为32周（范围21 - 44周）。术后，所有患者均佩戴长臂石膏4周。4周时取出钢针和石膏，开始活动。对肘部X线片进行评估，以观察骨折愈合情况、关节面的一致性、畸形愈合、生长紊乱以及有无缺血性坏死。记录活动范围、功能、疼痛和外观畸形情况。
所有患者均具有完全的主动和被动活动范围。与对侧相比，活动范围无差异（P < 0.05）。所有骨折在4周时均在X线片上愈合。没有不愈合或畸形愈合的病例。没有患者出现肘内翻。1例患者出现了肱骨小头透亮区。没有其他并发症。
小儿肱骨外侧髁骨折的关节镜复位和经皮固定可能是一种安全有效的替代开放治疗的方法，可减少软组织剥离，可能降低畸形愈合或缺血性坏死的风险。
IV级。
