Slongo Theddy, Schmid Timo, Wilkins Kaye, Joeris Alexander
Department of Surgical Pediatrics, Children's Hospital, University of Berne, CH-3010 Berne, Switzerland.
J Bone Joint Surg Am. 2008 Aug;90(8):1690-7. doi: 10.2106/JBJS.G.00528.
Percutaneous Kirschner wire fixation represents the classic treatment for displaced supracondylar humeral fractures in childhood. This type of treatment first requires satisfactory reduction of the fracture. Failure to achieve a satisfactory reduction or inadequate stabilization can result in instability of the fracture fragments, which can result in either an unsatisfactory cosmetic or functional outcome. In our experience, these problems can be overcome with the use of a small lateral external fixator.
Between 1999 and 2005, thirty-one of 170 Gartland type-III supracondylar humeral fractures were treated with a lateral external fixator. The outcome of treatment was analyzed with regard to limb alignment, elbow movement, cosmetic appearance, and patient satisfaction.
In twenty-eight of the thirty-one patients, a satisfactory reduction was achieved with closed methods. All children except one had a normal or good range of movement. The cosmetic result was excellent in all cases. All of the children and their parents stated that they would choose this treatment again.
The use of a small lateral external fixator seems to be a safe alternative for the treatment of displaced supracondylar fractures of the humerus when a closed reduction appears to be unattainable by means of manipulation alone or when sufficient stability is not achieved with standard methods of Kirschner wire fixation.
经皮克氏针固定是儿童肱骨髁上骨折移位的经典治疗方法。这种治疗首先需要对骨折进行满意的复位。未能实现满意的复位或固定不充分会导致骨折碎片不稳定，进而可能导致外观或功能结果不理想。根据我们的经验，使用小型外侧外固定器可以克服这些问题。
1999年至2005年间，170例Gartland III型肱骨髁上骨折中的31例采用外侧外固定器治疗。从肢体对线、肘关节活动度、外观及患者满意度方面对治疗结果进行分析。
31例患者中有28例通过闭合方法实现了满意的复位。除1例儿童外，所有儿童的活动范围均正常或良好。所有病例的外观效果均极佳。所有儿童及其父母均表示会再次选择这种治疗方法。
当仅通过手法无法实现闭合复位或采用标准克氏针固定方法无法获得足够稳定性时，使用小型外侧外固定器似乎是治疗肱骨髁上移位骨折的一种安全替代方法。
