Department of Trauma and Orthopaedic Surgery, Mid-Western Regional Orthopaedic Hospital, Limerick, Ireland.
Injury. 2010 Jun;41(6):568-71. doi: 10.1016/j.injury.2009.08.020. Epub 2009 Sep 25.
The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.
We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period. The primary end points were a major loss of reduction as determined by radiological alignment and iatrogenic ulnar nerve injury. Secondary end points included clinical alignment, elbow range of motion and complications.
A total of 43 patients, who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type II and type III) of the humerus were reviewed with a mean follow-up time of 36 months. No major loss of reduction occurred. The mean change in Baumann's angle (4.2+/-1.6 degrees) between intra-operative and follow-up radiographs was not significant (p>0.05). No iatrogenic case of ulnar nerve injury occurred. The 'carrying angle' and 'return to function' in all children had returned to normal relative to the other side. Postoperative complications consisted of three patients developing pin-site infections, which were successfully treated.
Dorgan's lateral cross-wiring technique is an effective option in treating displaced supracondylar fractures of the humerus in children. It is as effective as the traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve injury.
目前，儿童移位性肱骨髁上骨折的治疗方法是闭合复位和经皮克氏针固定。本研究的目的是回顾性分析一种新的交叉布线技术，该技术仅从外侧实现交叉布线配置，从而降低尺神经损伤的风险。
我们回顾性分析了在我们中心接受该手术的所有儿童患者，时间跨度为 10 年。主要终点是根据影像学对线和医源性尺神经损伤来确定的主要复位丢失。次要终点包括临床对线、肘部活动范围和并发症。
共 43 例肱骨髁上骨折（Gartland Ⅱ型和Ⅲ型）患儿接受了外侧交叉布线，平均随访时间为 36 个月。没有发生主要复位丢失。术中与随访时的 Baumann 角（4.2+/-1.6 度）变化不显著（p>0.05）。没有发生医源性尺神经损伤。所有患儿的“携带角”和“功能恢复”均恢复正常，与健侧相比。术后并发症包括 3 例发生针道感染，经治疗后均痊愈。
Dorgan 外侧交叉布线技术是治疗儿童移位性肱骨髁上骨折的有效方法。与传统的交叉布线技术相比，在骨折愈合方面同样有效，且尺神经损伤风险降低。
