Department of Orthopaedics, UCLA Orthopaedic Hospital, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 16-155 CHS, Los Angeles, CA 90095.
J Bone Joint Surg Am. 2011 May 4;93(9):871-7. doi: 10.2106/JBJS.J.00935.
Temporary elbow stiffness is often seen after a lateral condylar fracture of the distal end of the humerus in children. There are scant scientific data available to assess the expected time frame for return of elbow motion after these injuries. The purpose of this study is to provide a prospective, longitudinal evaluation of elbow motion in a large group of pediatric patients undergoing treatment for a lateral condylar fracture of the distal end of the humerus.
We prospectively evaluated 141 patients with lateral humeral condylar fractures at a mean age of 5.2 years and with a mean follow-up of twenty-nine weeks. The patients were treated with cast immobilization, percutaneous pinning, or open reduction and internal fixation on the basis of the initial displacement. Elbow motion was followed longitudinally at clinic visits. Relative arc of motion was calculated as a percentage of the motion of the normal, contralateral elbow.
The mean relative arc of motion at the time of cast removal was 44%, reaching 84% by week 12. By weeks 18, 24, 36, and 48, the relative arc of motion reached 87%, 90%, 93%, and 97%, respectively. Compared with fractures treated without surgery, those treated surgically had a significantly lower absolute arc of motion from the time of cast removal (p = 0.018) and up to eighteen weeks after the injury (p < 0.001); however, no significant difference was observed at eighteen weeks or beyond. For patients treated surgically, no significant difference in relative arc of motion was observed between the patients with closed or open reductions. The age of the patient (hazard ratio = 0.87, p = 0.008), length of immobilization (hazard ratio = 0.79, p = 0.03), and severity of the fracture (hazard ratio = 0.40, p < 0.0001) were independent predictors of recovery of elbow motion after a lateral humeral condylar fracture in children.
An initial rapid recovery in elbow motion can be expected after a lateral humeral condylar fracture in a child, with progressive improvements for up to one year after the injury. This recovery is slower if the patient is older, has a longer period of immobilization, and has a more severe injury.
儿童肱骨远端髁间骨折后常出现肘部暂时僵硬。目前，评估此类损伤后肘部活动恢复的预期时间范围的科学数据很少。本研究的目的是对接受治疗的大量儿童患者的肘部运动进行前瞻性、纵向评估，这些患者患有肱骨远端外侧髁骨折。
我们前瞻性评估了 141 例平均年龄为 5.2 岁的儿童肱骨外侧髁间骨折患者，平均随访 29 周。根据初始移位情况，采用石膏固定、经皮克氏针固定或切开复位内固定治疗。在就诊时通过纵向随访评估肘部运动。相对运动弧以正常对侧肘部运动的百分比计算。
去除石膏时的平均相对运动弧为 44%，第 12 周时达到 84%。第 18、24、36 和 48 周时，相对运动弧分别达到 87%、90%、93%和 97%。与未接受手术治疗的骨折相比，接受手术治疗的骨折患者在去除石膏时（p=0.018）和受伤后 18 周时（p<0.001）的绝对运动弧明显较低；然而，在 18 周或更久时，没有观察到显著差异。对于接受手术治疗的患者，闭合复位或开放复位之间的相对运动弧无显著差异。患者年龄（风险比=0.87，p=0.008）、固定时间（风险比=0.79，p=0.03）和骨折严重程度（风险比=0.40，p<0.0001）是儿童肱骨外侧髁间骨折后肘部运动恢复的独立预测因素。
儿童肱骨远端外侧髁骨折后，肘部运动可迅速恢复，受伤后 1 年内逐渐改善。如果患者年龄较大、固定时间较长、骨折程度较重，恢复速度较慢。
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