Sağlam Necdet, Saka Gürsel, Kurtulmuş Tuhan, Cem Coşkun Avcı, Türker Mehmet
Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey,
Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1101-5. doi: 10.1007/s00590-013-1288-9. Epub 2013 Aug 11.
The very rare isolated medial humeral condyle fractures in children and adolescents pose significant problems to orthopedic surgeons such as ulnar nerve injury, trochlear irregularities, fishtail deformity and motion loss. Six adolescent boys with displaced medial humeral condyle fractures with an average age of 14.8 (range 12-17) were included in this study. Patients were followed-up with a mean of 39.8 months (range 21-72). In three patients, there were clinical signs of ulnar nerve dysfunction at initial presentation. Of these, two had only mild hypoesthesia on the ulnar side. The other patient had sensory and motor loss of ulnar nerve at initial presentation complicated by hypothenar atrophy and anhydrosis during follow-up. Complete recovery was seen in this patient only at 2 years. One patient without a neurologic compliant at initial presentation developed mild hypoesthesia on the ulnarly innervated areas postoperatively with complete resolution. Medial skin incision was used for open reduction and internal fixation. No signs of gross morphologic damage were seen on the nerve. The symptoms resolved postoperatively in 3 months time in three of the patients, but in the remaining one, it took 2 years for complete resolution of the symptoms. Also, trochlear irregularity and fishtail deformity were seen on radiographs of two different patients. In all but one patients, motion loss ranging from 10° to 20° was evident on physical examination. The most important finding of this study revealed that transient ulnar nerve dysfunction was seen two-thirds of the patients in this series than any other series reported previously. In three series, only one case of ulnar nerve injury was reported from a total of 19 patients. A possible explanation for such a difference may be the older age in this series.
儿童和青少年中极为罕见的孤立性肱骨内侧髁骨折给骨科医生带来了诸多重大问题，如尺神经损伤、滑车不平整、鱼尾状畸形和活动丧失。本研究纳入了6名平均年龄为14.8岁（范围12 - 17岁）的肱骨内侧髁移位骨折的青春期男孩。患者平均随访39.8个月（范围21 - 72个月）。3例患者在初次就诊时有尺神经功能障碍的临床体征。其中，2例仅在尺侧有轻度感觉减退。另1例患者在初次就诊时出现尺神经感觉和运动丧失，随访期间并发小鱼际肌萎缩和无汗。该患者仅在2年后完全恢复。1例初次就诊时无神经症状的患者术后在尺神经支配区域出现轻度感觉减退，症状完全缓解。采用内侧皮肤切口进行切开复位内固定。神经未见明显形态学损伤迹象。3例患者术后3个月症状缓解，但其余1例患者症状完全缓解则花费了2年时间。另外，在2例不同患者的X线片上可见滑车不平整和鱼尾状畸形。除1例患者外，所有患者体格检查均有10°至20°的活动丧失。本研究最重要的发现是，该系列中三分之二的患者出现了短暂性尺神经功能障碍，这一比例高于以往报道的任何系列。在三个系列中，总共19例患者中仅报告了1例尺神经损伤。这种差异的一个可能解释可能是该系列患者年龄较大。
