Bashyal Ravi K, Chu Jennifer Y, Schoenecker Perry L, Dobbs Matthew B, Luhmann Scott J, Gordon J Eric
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA.
J Pediatr Orthop. 2009 Oct-Nov;29(7):704-8. doi: 10.1097/BPO.0b013e3181b768ac.
Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications.
A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases.
The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the operating room for repeat reduction and pinning. Three patients developed compartment syndromes. Ulnar nerve injury was rare with only 1 postoperative ulnar nerve injury occurring in 311 patients treated with a medial pin (0.3%).
Closed reduction with percutaneous pinning is effective and has a low complication rate with a very low rate of infection even when simple betadine preparation and towel draping are used. Preoperative antibiotics seem to have little effect on infection rate.
Level III retrospective comparative study.
肱骨远端髁上骨折是儿童最常见的骨骼损伤之一。北美目前的首选治疗方法是闭合复位经皮穿针固定。外科医生通常将钢针留在石膏下但在皮肤外暴露。术前皮肤准备和围手术期抗生素给药存在很大差异。关于感染率和其他并发症的数据很少。本研究的目的是回顾一大系列儿童病例，以评估感染率和其他并发症。
对我们机构在11年期间治疗的所有患者进行回顾性研究。共确定622例患者，在拔除钢针后至少随访2周。17例为屈曲型骨折，294例为II型骨折，311例为III型骨折。74例骨折（11.9%）术前存在神经功能缺损，其中骨间前神经麻痹最为常见（33例，5.3%）。163例患者（26.2%）术前使用了抗生素。362例患者采用喷雾和巾单铺巾，65例患者采用涂擦和巾单铺巾，146例患者采用酒精涂擦和巾单铺巾，13例患者采用全面准备和铺巾。591例骨折（95%）的钢针留在石膏下暴露，31例骨折（5.0%）的钢针埋于皮下。311例骨折放置了内侧钢针，其中18例通过小切口辅助放置。
最常见的并发症是钢针移位，11例患者（1.8%）需要意外返回手术室拔除钢针。1例患者发生深部感染，伴有化脓性关节炎和骨髓炎（0.2%）。另外5例患者发生浅表皮肤感染，经口服抗生素治疗，622例患者中总感染率为6例（1.0%）。1例患者最终出现骨不连，另外4例返回手术室进行再次复位和穿针。3例患者发生骨筋膜室综合征。尺神经损伤罕见，在311例接受内侧钢针治疗的患者中仅发生1例术后尺神经损伤（0.3%）。
经皮穿针闭合复位有效，并发症发生率低，即使使用简单的碘伏准备和巾单铺巾，感染率也非常低。术前抗生素似乎对感染率影响不大。
III级回顾性比较研究。
