Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
J Am Acad Orthop Surg. 2012 Feb;20(2):69-77. doi: 10.5435/JAAOS-20-02-069.
Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. Type I fractures are managed nonsurgically, but most displaced injuries (types II, III, and IV) require surgical intervention. Closed reduction and percutaneous pinning remains the mainstay of surgical management. Numerous studies have reported recent alterations in important aspects of managing these fractures. Currently, many surgeons wait until 12 to 18 hours after injury to perform surgery provided the child's neurovascular and soft-tissue statuses permit. Increasingly, type II fractures are managed surgically; cast management is reserved for fractures with extension displacement only. Two to three lateral pins are adequate for stabilizing most fractures. Evolving management concepts include those regarding pin placement, the problems of a pulseless hand, compartment syndrome, and posterolateral rotatory instability.
肱骨髁上骨折是儿童中最常见的肘部骨折。Ⅰ型骨折采用非手术治疗，但大多数移位损伤（Ⅱ型、Ⅲ型和Ⅳ型）需要手术干预。闭合复位和经皮钢针固定仍然是手术治疗的主要方法。许多研究报告了近期在这些骨折处理的重要方面的改变。目前，许多外科医生会等到受伤后 12 至 18 小时才进行手术，只要患儿的神经血管和软组织状况允许。越来越多的Ⅱ型骨折采用手术治疗；仅对有伸展移位的骨折采用石膏固定。两到三根外侧钢针足以稳定大多数骨折。不断发展的治疗理念包括关于钢针放置、无脉搏手的问题、骨筋膜室综合征和后外侧旋转不稳定的问题。
