Fayssoux Reginald S, Stankovits Lawrence, Domzalski Marcin E, Guille James T
Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
J Pediatr Orthop. 2008 Mar;28(2):142-6. doi: 10.1097/BPO.0b013e3181653af3.
To our knowledge, there is no report in the English-language literature of metaphyseal-diaphyseal junction fractures of the distal humerus in children. The purpose of this study was to review our experience with this uncommon fracture.
Between 1998 and 2004, 422 displaced supracondylar humerus fractures underwent operative reduction and fixation at our institution. A retrospective review of medical records and radiographs revealed that 14 (3.3%) of these fractures occurred at the metaphyseal-diaphyseal junction just proximal to the olecranon fossa. In 8 patients, the fracture line was oblique (group A), and in 6 patients, the fracture line was transverse (group B).
Average age at the time of fracture was 4.9 years (range, 1.5-10 years). All patients were treated by closed reduction and Kirschner wire fixation and had at least 1-year follow-up. In group A, operative time for reduction and fixation was significantly increased in comparison to the 408 remaining supracondylar humerus fractures. However, the clinical course in group A was uncomplicated, and no loss of fixation at follow-up was noted. The operative time in group B was even longer. These fractures were more problematic as loss of fixation occurred in 5 of the 6 patients, 4 occurring in the sagittal plane. In addition, multiple complications arose in group B including reoperation, cubitus varus, pin migration, and prolonged loss of motion.
Metaphyseal-diaphyseal junction fractures of the distal humerus in children are rare but can be problematic. The transverse fracture pattern requires additional attention in the operating room with optimal pin fixation. Close postoperative follow-up is necessary. The oblique fracture pattern, while requiring increased time in the operating room for reduction and fixation, is typically stable with the usual fixation used for supracondylar humerus fractures. In summary, metaphyseal-diaphyseal junction fractures of the distal humerus are uncommon elbow fractures in children that should be differentiated from the more common supracondylar humerus fracture for optimal outcomes.
Therapeutic level 4 (case series).
据我们所知，英文文献中尚无关于儿童肱骨远端干骺端-骨干交界处骨折的报道。本研究的目的是回顾我们对这种罕见骨折的治疗经验。
1998年至2004年间，我们机构对422例移位的肱骨髁上骨折进行了切开复位内固定术。对病历和X线片进行回顾性分析发现，其中14例（3.3%）骨折发生在鹰嘴窝近端的干骺端-骨干交界处。8例患者骨折线为斜形（A组），6例患者骨折线为横行（B组）。
骨折时的平均年龄为4.9岁（范围1.5 - 10岁）。所有患者均采用闭合复位和克氏针固定，并至少随访1年。与其余408例肱骨髁上骨折相比，A组的复位和固定手术时间显著延长。然而，A组的临床过程无并发症，随访时未发现固定失败。B组的手术时间更长。这些骨折问题较多，6例患者中有5例出现固定失败，4例发生在矢状面。此外，B组还出现了多种并发症，包括再次手术、肘内翻、钢针移位和长期活动受限。
儿童肱骨远端干骺端-骨干交界处骨折罕见但可能存在问题。横行骨折类型在手术室需要特别注意，采用最佳的钢针固定。术后密切随访是必要的。斜形骨折类型虽然在手术室复位和固定需要更多时间，但采用肱骨髁上骨折常用的固定方法通常是稳定的。总之，肱骨远端干骺端-骨干交界处骨折是儿童少见的肘部骨折，为获得最佳治疗效果，应与更常见的肱骨髁上骨折相鉴别。
治疗性4级（病例系列）。
