Tan Bryan Hsi Ming, Mahadev Arjandas
Department of Orthopaedic Surgery, National University Health System, Singapore.
J Orthop Surg (Hong Kong). 2011 Aug;19(2):209-12. doi: 10.1177/230949901101900216.
To review records of 108 children with radial neck fractures and develop an algorithm for treatment.
Records of 50 girls and 58 boys aged 2 to 14 (mean, 8.7) years with radial neck fractures were reviewed. The most common injury mechanism was tripping and falling on an outstretched hand while running (n=44), followed by falling from monkey bars (n=11). Fractures were classified into grade 1 (n=25), grade 2 (n=60), grade 3 (n=16), grade 4a (n=6), and grade 4b (n=1). 21 patients had associated fractures involving the olecranon, proximal ulna, and/or the humeral supracondyle. The time from injury to treatment ranged from 0 to 7 days. Treatments included casting without manipulation (n=86), closed reduction and casting (n=8), percutaneous Kirschner wire-assisted reduction and casting (n=7), and open reduction and casting (n=7).
Patients were followed up for a mean of 2.7 (range, 1-5) years. Outcome was excellent in 93 patients, good in 11, and fair in 4. Higher fracture grades correlated positively with poorer outcomes (p=0.001) and more invasive treatment (p=0.001). Nonetheless, the post-reduction angles of all the patients were not significantly different (p>0.05). Older children sustained more severe fractures (p=0.04) and had poorer outcomes, even after correction for fracture grade (p=0.007). Patients with associated fractures had significantly poorer outcomes (p<0.05). Two patients developed synostosis of the proximal radioulnar joint. One of whom had an associated olecranon fracture and underwent open reduction and casting. The other had an associated proximal ulnar fracture and underwent repeated percutaneous Kirschner wire-assisted reduction owing to loss of reduction. Five patients developed heterotopic ossification. Four of whom had associated fractures (3 involved the olecranon and one the proximal ulna). 14 patients developed cubitus valgus deformity of 3º to 10º.
Open reduction should only be performed after more conservative treatments fail to achieve reduction.
回顾108例儿童桡骨颈骨折的病例记录并制定治疗方案。
回顾了50例女孩和58例男孩的病例记录，这些患儿年龄在2至14岁（平均8.7岁），均为桡骨颈骨折。最常见的受伤机制是跑步时绊倒并伸手撑地（n = 44），其次是从单杠上跌落（n = 11）。骨折分为1级（n = 25）、2级（n = 60）、3级（n = 16）、4a级（n = 6）和4b级（n = 1）。21例患者合并有涉及尺骨鹰嘴、尺骨近端和/或肱骨髁上的骨折。受伤至治疗的时间为0至7天。治疗方法包括非手法复位石膏固定（n = 86）、闭合复位石膏固定（n = 8）、经皮克氏针辅助复位石膏固定（n = 7）和切开复位石膏固定（n = 7）。
患者平均随访2.7年（范围1至5年）。93例患者预后优秀，11例良好，4例一般。骨折分级越高，预后越差（p = 0.001），治疗侵入性越强（p = 0.001）。尽管如此，所有患者复位后的角度差异无统计学意义（p>0.05）。年龄较大的儿童骨折更严重（p = 0.04），即使校正骨折分级后预后仍较差（p = 0.007）。合并骨折的患者预后明显较差（p<0.05）。2例患者发生了近端桡尺关节融合。其中1例合并尺骨鹰嘴骨折，接受了切开复位石膏固定。另1例合并尺骨近端骨折，因复位丢失而接受了多次经皮克氏针辅助复位。5例患者发生了异位骨化。其中4例合并骨折（3例涉及尺骨鹰嘴，1例涉及尺骨近端）。14例患者出现了3°至10°的肘外翻畸形。
只有在更保守的治疗方法无法实现复位后才应进行切开复位。
