Pediatric Orthopedics Dept, Dupuytren University Hospital, Hôpital Mère-Enfant, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France.
Orthop Traumatol Surg Res. 2011 May;97(3):304-7. doi: 10.1016/j.otsr.2010.10.007. Epub 2011 Apr 7.
Distal humerus condyle fracture in children is rare. These fractures often mislead the emergency physician or surgeon. However, treatment adapted to the degree of displacement achieves excellent clinical and radiographic results. The objective of this study was to clarify indications for conservative treatment of lateral humeral condyle fracture in children.
Twenty-two children who had sustained lateral humeral condyle fracture between January 2007 and January 2010 were reviewed in April 2010. At this consultation, the children underwent clinical and radiological examination. The Hardacre functional score was used to determine objective clinical outcome.
Conservative treatment was exclusive to cases of lateral condyle displacement equal to or less than 1mm. All other fractures were managed by surgical open reduction and fixation using cross-pinning. There was no statistically significant difference in clinical or radiological outcome between conservative and surgical management.
Lateral humeral condyle fracture is difficult to diagnose in children. The majority of poor results reported in literature relate to inadequate initial treatment. Given a radiological aspect of hemarthrosis of the elbow, the emergency physician prescribes multiple X-ray views of the affected elbow (anteroposterior, lateral and internal oblique). The clinical aspect of lateral humeral condyle fracture is often characteristic (ecchymosis facing the head of the radius). Nondisplaced or minimally displaced lateral humeral condyle fracture can be managed conservatively under close survey. However, secondary displacement under the cast is often difficult or impossible to detect, and outpatient surgery is therefore being increasingly indicated in our department.
儿童肱骨远端髁骨折很少见。这些骨折常使急诊医师或外科医生误诊。然而，根据移位程度进行的治疗可获得良好的临床和影像学结果。本研究的目的是明确儿童肱骨外髁骨折保守治疗的适应证。
2010 年 4 月回顾了 2007 年 1 月至 2010 年 1 月期间发生的 22 例儿童肱骨外髁骨折。在这次就诊时，患儿接受了临床和影像学检查。使用 Hardacre 功能评分来确定客观的临床结果。
仅当外侧髁骨移位等于或小于 1mm 时，才采用保守治疗。所有其他骨折均采用交叉钉固定的手术切开复位治疗。保守治疗与手术治疗的临床和影像学结果无统计学差异。
儿童肱骨外髁骨折难以诊断。文献中报道的大多数不良结果与初始治疗不当有关。鉴于肘部关节积血的影像学表现，急诊医师会开出受累肘部的多个 X 射线（前后位、侧位和斜位）。肱骨外髁骨折的临床特征通常很明显（面对桡骨头的瘀斑）。无移位或轻度移位的肱骨外髁骨折可在密切观察下保守治疗。然而，石膏下的继发性移位通常难以或不可能检测到，因此我们科室越来越多地进行门诊手术。
