Pant Ajay, Huda N, Ahmed Wasim
Assistant Professor, Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre (TMMCRC) ; Moradabad, UP, India .
J Clin Diagn Res. 2013 Aug;7(8):1666-8. doi: 10.7860/JCDR/2013/5695.3227. Epub 2013 Aug 1.
Intercondylar (T-Condylar) fractures of the humerus are very rare in children. The usual mechanism of the injury which is involved is a fall on a flexed elbow. The treatment options vary, depending upon the degree of the displacement and the amount of comminution and; they may range from a simple application of traction to open reduction and internal fixation with plates and screws. Open reduction is associated with significant post-operative stiffness of the elbow and subsequent less than satisfactory functional results. In this publication, we are presenting our experience of treating seven adolescent T-Condylar fractures of the distal humerus with closed reductions and internal fixations with the percutaneus Kirchner ('K') wire.
Seven patients (M:F-6:1) with an average age of 14(range 12-16) years were treated by closed reduction and internal fixation with a 2.0 mm 'K' wire fixation under an image intensifier. Following the surgery, all the elbows were immobilised in plaster of Paris (POP) splints for three weeks. At three weeks after the surgery, the pop splints were removed and gentle elbow exercises were started. Five weeks after the surgery, the 'K' wires were removed, based on the radiological evidence of a bridging callus formation.
Six patients (85%) out of seven showed satisfactory functional results on the Mayo Elbow Performance Score (MEPS), with a good range of motion at the elbow joint. Three (42%) patients had mild elbow stiffness, which resolved on subsequent treatment, while one (14%) had a mild pin tract infection, who was managed conservatively. There was one patient (14%) who was lost to follow-up, who ultimately had a painful and a stiff elbow. The remaining six patients were able to return to the premorbid sate.
We recommend closed reduction and percutaneous 'K' wire fixation for adolescent T- Condylar fractures of the humerus as an easy and inexpensive procedure with satisfactory functional results.
儿童肱骨髁间（T型髁间）骨折非常罕见。常见的受伤机制是屈曲的肘部着地。治疗方案因移位程度和粉碎程度而异，范围从简单的牵引应用到钢板螺钉切开复位内固定。切开复位与术后肘部明显僵硬以及随后不太理想的功能结果相关。在本出版物中，我们介绍了用闭合复位和经皮克氏针内固定治疗7例青少年肱骨远端T型髁间骨折的经验。
7例患者（男∶女为6∶1），平均年龄14岁（范围12 - 16岁），在影像增强器引导下采用闭合复位和2.0毫米克氏针内固定治疗。术后，所有肘部均用巴黎石膏（POP）夹板固定3周。术后3周，拆除POP夹板并开始轻柔的肘部锻炼。术后5周，根据骨痂桥接形成的影像学证据取出克氏针。
7例患者中有6例（85%）根据梅奥肘关节功能评分（MEPS）显示功能结果满意，肘关节活动范围良好。3例（42%）患者有轻度肘部僵硬，经后续治疗后缓解，而1例（14%）有轻度针道感染，采用保守治疗。有1例患者（14%）失访，最终肘部疼痛且僵硬。其余6例患者能够恢复到病前状态。
我们推荐对青少年肱骨T型髁间骨折采用闭合复位和经皮克氏针固定，这是一种简单且经济的手术，功能结果令人满意。
