Rizk Ahmed Shawkat
Orthopaedics and Traumatology Department, Faculty of Medicine, Benha University, Benha, Egypt,
J Orthop Traumatol. 2015 Jun;16(2):105-16. doi: 10.1007/s10195-015-0334-2. Epub 2015 Jan 22.
Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14 days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children.
This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49 months, with a mean period of 17 months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria.
All fractures united in a mean duration of 7.2 weeks (range 5-10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66 %), while good results were found in two patients (13.33 %) according to the MEPI scale. According to the Mark functional criteria, there was one patient with a fair result (6.66 %).
The results were very satisfactory if compared with traditional operative techniques, with many advantages including anatomical reduction and fixation of the fractures, avoidance of ulnar nerve injury, preservation of the extensor mechanism, decrease in incidence of myositis ossificans around the elbow and decrease in post-operative stiffness.
IV.
肱骨髁上骨折是儿童最常见的骨骼损伤之一。对于移位和不稳定的病例，标准治疗方法是早期闭合复位及经皮克氏针固定。然而，10%至20%的患者就诊较晚。根据文献，骨折被延误治疗的患者是指受伤14天后才前来治疗的患者。延误的原因要么是缺乏医疗设施，要么是社会和经济限制。这些被延误治疗的病例通常为闭合性损伤，无血管损伤。然而，肘部可能仍有紧张和肿胀，并伴有擦伤或痂皮。在被延误治疗的病例中，尤其是在早期出现骨痂后，已没有进行闭合复位和经皮穿针固定的机会。传统上，肱骨远端骨折采用的手术方法会破坏伸肌机制，由于肱三头肌无力和肘关节僵硬，功能结果不太理想。本研究的目的是评估采用保留肱三头肌入路及克氏针固定进行延迟切开复位治疗儿童被延误治疗的、移位的肱骨髁上和远端骨折的疗效。
本前瞻性研究纳入了15例被延误治疗的移位肱骨髁上和远端骨折患儿。所有患者在干预前、术后及随访期间均进行了全面的临床和影像学评估。随访时间为8至49个月，平均为17个月。根据梅奥肘关节功能指数（MEPI）和马克功能标准评估功能结果。
所有骨折平均在7.2周（5至10周）内愈合，无二次移位或畸形愈合。根据MEPI量表，在研究的15例患者中，13例（86.66%）在最后一次随访时结果为优，2例（13.33%）结果为良。根据马克功能标准，有1例患者结果为中（6.66%）。
与传统手术技术相比，结果非常令人满意，具有许多优点，包括骨折的解剖复位和固定、避免尺神经损伤、保留伸肌机制、降低肘部周围骨化性肌炎的发生率以及降低术后僵硬程度。
IV级。
