Fitzgibbons Peter G, Bruce Ben, Got Christopher, Reinert Steve, Solga Patricia, Katarincic Julie, Eberson Craig
Department of Orthopaedics, Dudley St, Providence, RI 02903, USA.
J Pediatr Orthop. 2011 Jun;31(4):372-6. doi: 10.1097/BPO.0b013e31821adca9.
Closed reduction and casting for type-2 supracondylar fractures is a viable treatment option, but studies have shown that some patients will fail to maintain the initial reduction in a cast. This study sought to identify predictors of failed treatment of closed reduction and casting for these fractures.
We performed a retrospective case-control study of type-2 supracondylar fractures treated by closed reduction and casting. Using radiographic failure of reduction as our primary outcome measure, we examined injury, postreduction, and follow-up films evaluating the anterior humeral line, cast flexion angle, and degree of cast padding in an attempt to identify predictors of failure.
We reviewed 645 fractures. Of 126 type-2 fractures, 61 fractures were included in the study. There were 49 (80%) nonoperative treatment successes and 12 failures (20%) with an average follow-up of 41 days (range, 20 to 161 d). We found that (1) the degree of fracture extension using an index based on the anterior humeral line on the injury film was significantly related to failure of cast treatment (P=<0.01), and (2) the width of the soft tissue shadow of the upper arm on the postreduction film was of borderline significance (P=0.02). Cast flexion angle and cast padding were not predictive of radiographic loss of reduction (P=0.94 and 0.70).
Despite adequate reduction and casting of type-2 supracondylar fractures, some fractures will lose reduction and require delayed pinning. The degree of extension of the distal fragment at the time of injury may help to predict the likelihood of failure of nonoperative treatment.
对于Ⅱ型肱骨髁上骨折，闭合复位及石膏固定是一种可行的治疗选择，但研究表明，一些患者无法维持石膏固定后的初始复位效果。本研究旨在确定这些骨折闭合复位及石膏固定治疗失败的预测因素。
我们对采用闭合复位及石膏固定治疗的Ⅱ型肱骨髁上骨折进行了一项回顾性病例对照研究。以复位的影像学失败作为主要结局指标，我们检查了损伤、复位后及随访时的X线片，评估肱骨前线、石膏屈曲角度及石膏衬垫程度，以试图确定失败的预测因素。
我们回顾了645例骨折。在126例Ⅱ型骨折中，61例纳入研究。49例（80%）非手术治疗成功，12例失败（20%），平均随访41天（范围20至161天）。我们发现：（1）根据损伤时X线片上的肱骨前线计算的骨折延伸程度与石膏治疗失败显著相关（P<0.01）；（2）复位后X线片上上臂软组织阴影宽度具有临界显著性（P=0.02）。石膏屈曲角度及石膏衬垫对复位的影像学丢失无预测价值（P=0.94和0.70）。
尽管Ⅱ型肱骨髁上骨折进行了充分的复位及石膏固定，但一些骨折仍会失去复位效果并需要延迟穿针固定。损伤时远端骨折块的延伸程度可能有助于预测非手术治疗失败的可能性。
