Beck Nicholas A, Ganley Theodore J, McKay Scott, Tomlinson Lauren, Ahn Jaimo, Flynn John M, Baldwin Keith
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
J Child Orthop. 2014 Mar;8(2):161-5. doi: 10.1007/s11832-014-0576-1. Epub 2014 Mar 19.
T-condylar fractures of the distal humerus are infrequent injuries in children. There are little data regarding outcomes in this age group. The adult literature demonstrates a high rate of postinjury stiffness. We describe a large series of T-condylar fractures in children and set out to identify factors that influence the postoperative range of motion (ROM) in children. Our hypothesis was that starting motion early (<3 weeks) would favorably influence the postoperative ROM.
Patients were identified based on the Current Procedural Terminology (CPT) code for ORIF of supracondylar distal humerus fractures with intracondylar extension (24546). Patient records and radiographs were reviewed to determine the demographics, fracture characteristics, surgical approach and fixation, and postoperative immobilization time. Our outcome measure was ROM in flexion/extension at 3 months, 6 months, 1 year, and final follow-up. Patients were analyzed by Morrey's criteria of -30° extension and 130° flexion to assess for postoperative elbow stiffness.
Thirty-eight potential patients from 1992 to 2010 were identified with specific T-condylar patterns. Twelve patients were excluded due to insufficient follow-up or lack of final ROM data. Our cohort included 26 patients (average age 13.4 years). The average postoperative immobilization time was 3.4 weeks (range 0.9-12 weeks). At the final follow-up, patients had -12° average extension and 130° average flexion. Nine patients (35 %) were stiff and 17 patients (65 %) had functional motion postoperatively. At 3 and 6 months, starting motion early yielded better flexion and extension ROM. Late-motion patients obtained similar results at the 1-year follow-up. Open fractures, gender, and age were all not significantly associated with elbow stiffness in our series, given the limited numbers.
Early ROM was associated with an earlier gain of functional motion without clear adverse consequences. Despite similar findings at the final follow-up, practitioners should consider instituting early ROM protocols to decrease the duration of stiffness and potential disability for the child and the family.
儿童肱骨远端T型髁上骨折较为罕见。关于该年龄组的治疗结果数据较少。成人文献显示伤后僵硬发生率较高。我们描述了一系列儿童T型髁上骨折病例，并着手确定影响儿童术后活动范围（ROM）的因素。我们的假设是早期活动（<3周）将对术后ROM产生有利影响。
根据肱骨髁上远端骨折切开复位内固定术（24546）的现行程序编码（CPT）确定患者。回顾患者记录和X线片以确定人口统计学资料、骨折特征、手术入路和固定方式以及术后固定时间。我们的结局指标是3个月、6个月、1年及末次随访时的屈伸ROM。根据Morrey标准（伸展-30°、屈曲130°）分析患者，以评估术后肘关节僵硬情况。
1992年至2010年共确定了38例具有特定T型髁上骨折模式的潜在患者。12例患者因随访不足或缺乏最终ROM数据而被排除。我们的队列包括26例患者（平均年龄为13.4岁）。术后平均固定时间为3.4周（范围0.9 - 12周）。末次随访时，患者平均伸展为-12°，平均屈曲为130°。9例患者（35%）出现僵硬，17例患者（65%）术后活动功能良好。在3个月和6个月时，早期活动的患者屈伸ROM更佳。晚期活动的患者在1年随访时获得了类似结果。鉴于数量有限，在我们的系列研究中，开放性骨折、性别和年龄均与肘关节僵硬无显著相关性。
早期ROM与功能活动的早期恢复相关，且无明显不良后果。尽管在末次随访时有类似发现，但从业者应考虑制定早期ROM方案，以缩短儿童及家庭的僵硬持续时间和潜在残疾时间。
