Song Kwang Soon, Kang Chul Hyung, Min Byung Woo, Bae Ki Cheor, Cho Chul Hyun, Lee Ju Hyub
Department of Orthopedic Surgery, School of Medicine, Keimyung University, 194 Dong san dong, Daegu 700-712, South Korea.
J Bone Joint Surg Am. 2008 Dec;90(12):2673-81. doi: 10.2106/JBJS.G.01227.
Open reduction and internal fixation of a displaced unstable fracture of the lateral condyle of the humerus in a child usually produces a good result. Only a few reports have focused on closed reduction and internal fixation of these fractures. We prospectively studied closed reduction and internal fixation to determine its usefulness as the initial treatment for displaced unstable fractures of the lateral condyle of the humerus.
We classified lateral condylar humeral fractures into five groups according to the degree of displacement and the fracture pattern as determined on four radiographic views and created an algorithm for the treatment of these fractures on the basis of this classification system. We prospectively treated sixty-three unstable fractures (in forty-two boys and twenty-one girls) and assessed the quality of closed reduction.
Thirteen of seventeen stage-3 fractures were reduced to < or =1 mm of residual displacement. Thirty of forty stage-4 fractures and three of six stage-5 fractures were reduced to < or =2 mm of displacement. In ten of forty stage-4 fractures and three of six stage-5 fractures, closed reduction to within 2 mm failed and open reduction and internal fixation was performed. There were no major complications such as osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest.
Closed reduction and internal fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in many children. If fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.
儿童肱骨外侧髁移位不稳定骨折的切开复位内固定通常能取得良好效果。仅有少数报道关注这些骨折的闭合复位内固定。我们前瞻性地研究了闭合复位内固定，以确定其作为肱骨外侧髁移位不稳定骨折初始治疗方法的有效性。
我们根据四个X线片视图确定的移位程度和骨折类型，将肱骨外侧髁骨折分为五组，并基于此分类系统创建了这些骨折的治疗算法。我们前瞻性地治疗了63例不稳定骨折（42例男孩和21例女孩），并评估了闭合复位的质量。
17例3期骨折中有13例复位后残余移位≤1mm。40例4期骨折中的30例和6例5期骨折中的3例复位后移位≤2mm。40例4期骨折中的10例和6例5期骨折中的3例，闭合复位至2mm以内失败，改行切开复位内固定。未出现诸如滑车或肱骨小头缺血性坏死、骨不连、畸形愈合或早期骨骺阻滞等严重并发症。
闭合复位内固定对许多儿童肱骨外侧髁不稳定移位骨折是一种有效的治疗方法。如果闭合复位后骨折移位超过2mm，建议行切开复位内固定。
