Fowles J V, Slimane N, Kassab M T
l'Institut National d'Orthopédie, Mohamed Kassab, Kassar Saïd, Tunisia.
J Bone Joint Surg Br. 1990 Jan;72(1):102-4. doi: 10.1302/0301-620X.72B1.2298765.
After dislocation of the elbow with avulsion of the medial epicondyle, the management of the latter is controversial. Of 28 children followed up after initial closed reduction of the elbow, 19 had a satisfactory closed reduction of the epicondyle and were treated in plaster. At follow-up, 11 children had a normal elbow and eight had lost an average of 15 degrees of flexion. Nine children had had open reduction and internal fixation of the fragment, one for an open injury, three for displacement of the epicondyle and six for intra-articular entrapment of the fragment. Five of these children had ulnar nerve contusion or compression, four requiring anterior transposition of the nerve. At review, only three had normal elbows and six had lost an average of 37 degrees of flexion. We agree with other authors that surgery is indicated only for children in whom the epicondyle is trapped in the joint or is significantly displaced after closed reduction.
肘关节脱位合并内上髁撕脱伤后，内上髁的处理存在争议。在28例肘关节初次闭合复位后接受随访的儿童中，19例内上髁闭合复位良好，采用石膏固定治疗。随访时，11例儿童肘关节正常，8例平均屈曲度丧失15度。9例儿童接受了骨折块的切开复位内固定，1例因开放性损伤，3例因内上髁移位，6例因骨折块关节内卡压。这些儿童中有5例尺神经挫伤或受压，4例需要行神经前置术。复查时，只有3例肘关节正常，6例平均屈曲度丧失37度。我们同意其他作者的观点，即仅对骨折块卡压在关节内或闭合复位后明显移位的儿童行手术治疗。
