Scaglione Michelangelo, Giovannelli Daniele, Fabbri Luca, Dell'omo Dario, Goffi Andrea, Guido Giulio
Department of Orthopedics, University of Pisa, Via Paradisa 2, Ed 3, 56100, Pisa, Italy.
Musculoskelet Surg. 2012 Aug;96(2):111-6. doi: 10.1007/s12306-012-0204-5. Epub 2012 Jul 22.
Supracondylar fractures of the humerus in children are important for frequency and type of associated serious complications. The management of this kind of fractures is still controversial (Skaggs et al. in J Bone Joint Surg Am 86:702-707, 2004; Kalllio et al. in J Pediatr Orthop 12:11-15, 1992). We are going to present our experience in the treatment of supracondylar humeral fracture in children. In the Orthopedic Department of Pisa, we treated 150 cases from 1989 to 2006. We are used to perform, emergency or within 12 h, reduction and two lateral-entry percutaneous pins fixation. The mean age was 7.5 years. We checked 125 cases, because we excluded all the cases with follow up less then 5 years. The mean follow up was 8.2 years. We used Gartland classification modified by Wilkins. We evaluated 125 cases by using the Flynn classification: 100 % of patients did not have impairment of the elbow joint mobility. We had seven valgus deviation, one of which was more then 10°. We also had 17 varus deviations, 11 of which were not over 8° and only 2 of them were 15°. The average value of the joint Baumann angle was calculated as great as 16°. The obtained results were classified as very good 80 %, good 11 %, sufficiently good 6 %, and bad 3 %. In our experience, all the fractures type II and III by Gartland have to be treated within 12 h, with closed reduction and stabilization with lateral-entry K-wire technique. The conservative treatment by cast is indicated only in type I fracture. The trans olecranic treatment is not realizable, for the stiffness which can occur, for the risk of iatrogenic ulnar nerve lesion, and for long-time hospitalization. The open reduction remains the first choice treatment for exposed or nonreducible fractures, and in cases of vascular injury.
儿童肱骨髁上骨折因其相关严重并发症的发生率和类型而备受关注。这类骨折的治疗方法仍存在争议（斯卡格斯等人，《美国骨与关节外科杂志》86:702 - 707, 2004；卡利奥等人，《小儿矫形外科学杂志》12:11 - 15, 1992）。我们将展示我们在儿童肱骨髁上骨折治疗方面的经验。在比萨的骨科，我们在1989年至2006年期间治疗了150例病例。我们习惯在急诊时或12小时内进行复位，并采用两根外侧入路经皮克氏针固定。平均年龄为7.5岁。我们检查了125例病例，因为我们排除了所有随访时间少于5年的病例。平均随访时间为8.2年。我们采用威尔金斯修改后的加特兰分类法。我们使用弗林分类法对125例病例进行评估：100% 的患者肘关节活动度未受影响。我们有7例外翻畸形，其中1例超过10°。我们还有17例内翻畸形，其中11例不超过8°，只有2例为15°。关节鲍曼角平均值经计算高达16°。所获结果分类如下：非常好80%，好11%，尚可6%，差3%。根据我们的经验，加特兰分类法中的所有II型和III型骨折都必须在12小时内进行治疗，采用闭合复位并用外侧入路克氏针技术固定。仅I型骨折适合采用石膏保守治疗。经鹰嘴治疗不可行，因为可能出现僵硬、有医源性尺神经损伤风险以及住院时间长。切开复位仍是开放性或不可复位骨折以及血管损伤病例的首选治疗方法。
