Camus Tristan, MacLellan Brent, Cook Peter Christopher, Leahey John Lorne, Hyndman John C, El-Hawary Ron
Division of Orthopaedic Surgery, Department of Surgery, IWK Health Centre, University Avenue, Halifax, Nova Scotia, Canada.
J Pediatr Orthop. 2011 Jun;31(4):366-71. doi: 10.1097/BPO.0b013e31821addcf.
The treatment of Gartland type II pediatric supracondylar humerus fractures remains controversial. Some argue that closed reduction and cast immobilization is sufficient to treat these fractures, whereas others advocate closed reduction and percutaneous pinning. The purpose of this radiographic outcomes study was to determine whether closed reduction and cast immobilization could successfully obtain and maintain acceptable reduction of extension type II supracondylar humerus fractures.
Prereduction, immediate postreduction, and final radiographs of 155 extension type II fractures that were treated nonoperatively were measured according to the parameters determined earlier to assess the position and alignment of the fracture fragments. These included the anterior humeral line, humerocapitellar angle, Baumann's angle, the Gordon index, and the Griffet index.
The average age of the 155 patients at the time of injury was 5.3 years (range: 1 to 13 y). Analysis of the final radiographs, at the final follow-up of 5.3 months, showed that in 80% of patients, the anterior humeral line remained anterior to the mid-third segment of the capitellum (radiographic extension deformity), the mean humerocapitellar angle was 23.77 degrees (range: -11 to 50 degrees), the mean Baumann's angle was 79.40 degrees (range: 62 to 97 degrees), the mean Gordon index was 4.59%, and 44% of patients had a Griffet index between 1 and 3.
From this radiographic review, it was observed that not all fractures treated with closed reduction and cast immobilization achieved anatomic position and alignment at final follow-up; however, the long-term clinical and radiographic significance of these findings remains unknown.
儿童肱骨髁上骨折Gartland II型的治疗仍存在争议。一些人认为闭合复位和石膏固定足以治疗这些骨折，而另一些人则主张闭合复位和经皮穿针固定。本影像学结果研究的目的是确定闭合复位和石膏固定能否成功获得并维持伸直型II型肱骨髁上骨折的可接受复位。
根据先前确定的参数，对155例接受非手术治疗的伸直型II型骨折的复位前、复位后即刻及最终X线片进行测量，以评估骨折碎片的位置和对线情况。这些参数包括肱骨前线、肱骨小头角、鲍曼角、戈登指数和格里费指数。
155例患者受伤时的平均年龄为5.3岁（范围：1至13岁）。在平均5.3个月的最终随访时对最终X线片进行分析，结果显示，80%的患者肱骨前线仍位于肱骨小头中1/3段的前方（影像学上的伸直畸形），肱骨小头角平均为23.77°（范围：-11°至50°），鲍曼角平均为79.40°（范围：62°至97°），戈登指数平均为4.59%，44%的患者格里费指数在1至3之间。
通过本次影像学回顾发现，并非所有接受闭合复位和石膏固定治疗的骨折在最终随访时都能达到解剖位置和对线；然而，这些结果的长期临床和影像学意义尚不清楚。
