Balakumar Balasubramanian, Madhuri Vrisha
Paediatric Orthopaedic Unit, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Orthop. 2012 Nov;46(6):690-7. doi: 10.4103/0019-5413.104219.
Loss of reduction following closed or open reduction of displaced supracondylar fractures of the humerus in children varies widely and is considered dependent on stability of the fracture pattern, Gartland type, number and configuration of pins for fixation, technical errors, adequacy of initial reduction, and timing of the surgery. This study was aimed to evaluate the factors responsible for failure of reduction in operated pediatric supracondylar fracture humerus.
We retrospectively assessed loss of reduction by evaluating changes in Baumann's angle, change in lateral rotation percentage, and anterior humeral line in 77 consecutive children who were treated with multiple Kirschner wire fixation and were available for followup. The intraoperative radiographs were compared with those taken immediately after surgery and 3 weeks postoperatively. Multivariate logistic regression analysis was performed by STATA 10.
Reduction was lost in 18.2% of the patients. Technical errors were significantly higher in those who lost reduction (P = 0.001; Odds Ratio: 57.63). Lateral pins had a significantly higher risk of losing reduction than cross pins (P = 0.029; Odds Ratio: 7.73). Other factors including stability of fracture configuration were not significantly different in the two groups.
The stability of fracture fixation in supracondylar fractures in children is dependent on a technically good pinning. Cross pinning provides a more stable fixation than lateral entry pins. Fracture pattern and accuracy of reduction were not important factors in determining the stability of fixation.
儿童肱骨髁上移位骨折闭合或切开复位后复位丢失情况差异很大，被认为取决于骨折类型的稳定性、加特兰（Gartland）分型、固定针的数量和构型、技术失误、初始复位的充分程度以及手术时机。本研究旨在评估小儿肱骨髁上骨折手术复位失败的相关因素。
我们回顾性评估了77例接受多根克氏针固定且可供随访的连续儿童患者，通过评估鲍曼（Baumann）角的变化、外侧旋转百分比的变化以及肱骨前线，来分析复位丢失情况。将术中X线片与术后即刻及术后3周所摄X线片进行比较。使用STATA 10进行多因素逻辑回归分析。
18.2%的患者出现复位丢失。复位丢失患者的技术失误明显更多（P = 0.001；比值比：57.63）。外侧针导致复位丢失的风险显著高于交叉针（P = 0.029；比值比：7.73）。两组中其他因素，包括骨折构型的稳定性，并无显著差异。
儿童髁上骨折固定的稳定性取决于技术良好的穿针操作。交叉穿针提供的固定比外侧入针更稳定。骨折类型和复位的准确性并非决定固定稳定性的重要因素。
