Eamsobhana Perajit, Kaewpornsawan Kamolporn
Department of Orthopaedics Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand,
Int Orthop. 2015 Aug;39(8):1579-85. doi: 10.1007/s00264-015-2805-8. Epub 2015 Jun 6.
Patients with nonunion of the lateral humeral condyle often present with pain, instability, progressive cubitus valgus and tardy ulnar nerve palsy. At present repairing of this nonunion is still controversial due to previous reported complications such as stiffness and avascular necrosis (AVN). This study reported the outcomes of treatment in nonunion of the lateral humeral condyle in children.
We evaluated 17 patients with nonunion of the lateral humeral condyle after repair. Corrective osteotomy was done in patients with valgus deformity of more than 30 degrees and anterior ulnar nerve transposition in patients with ulnar nerve symptoms. Evaluations were performed with the use of radiographic examination, clinical assessment and also evaluated using Mayo Elbow Performance score by interview and physical examination interpreted as excellent (≥ 90 points), good (75-89 points), fair (60-74 points), and poor (<60 points).
Nine patients were male, and eight were female. The mean age at presentation was 6.5 years. The average interval from the injury to the presentation of the symptoms was 31.5 months. The average duration of follow-up was 48.6 months. The range of flexion was 130-145° (average 130°). The Mayo elbow performance score was excellent in 11 patients and good in six patients. Mean Mayo elbow performance score was 94. Osseous union was achieved after the initial operation in 16 patients. One patient had re-operation using local bone graft and healed nicely. Determination of correlation coefficients found good correlation between neglected time and Mayo performance score <89 (-0.741), age of patient was fairly well correlated with Mayo performance score <89 (-0.635) and ROC curve show that neglected lateral condyle fracture in children more than 28 months will reduce the Mayo score.
(1) We support osteosynthesis for children, not only for those who have pain but also for those who are less symptomatic. Good and excellent results by Mayo elbow performance score were found in all patients, and all nonunions were united with good range of motion. (2) Neglecting lateral condyle fracture in children more than 28 months will reduce Mayo performance score to below 89 points. (3) Cases presenting with AVN pre-operatively can still have good results and remodeling potential with congruency of the joint.
肱骨外侧髁骨不连患者常出现疼痛、不稳定、进行性肘外翻及迟发性尺神经麻痹。目前，由于既往报道的诸如僵硬和缺血性坏死（AVN）等并发症，这种骨不连的修复仍存在争议。本研究报告了儿童肱骨外侧髁骨不连的治疗结果。
我们评估了17例肱骨外侧髁骨不连修复术后的患者。对肘外翻畸形超过30度的患者进行截骨矫正，对有尺神经症状的患者进行尺神经前置术。通过影像学检查、临床评估进行评价，并通过访谈和体格检查使用Mayo肘关节功能评分进行评估，评分解释为优秀（≥90分）、良好（75 - 89分）、中等（60 - 74分）和差（<60分）。
9例为男性，8例为女性。就诊时的平均年龄为6.5岁。从受伤到出现症状的平均间隔时间为31.5个月。平均随访时间为48.6个月。屈曲范围为130 - 145°（平均130°）。11例患者Mayo肘关节功能评分为优秀，6例为良好。Mayo肘关节功能评分平均为94分。16例患者在初次手术后实现了骨愈合。1例患者再次手术并使用局部骨移植，愈合良好。相关性系数测定发现，漏诊时间与Mayo功能评分<89分之间存在良好相关性（-0.741），患者年龄与Mayo功能评分<89分之间相关性较好（-0.635），ROC曲线显示，儿童肱骨外侧髁骨折漏诊超过28个月会降低Mayo评分。
（1）我们支持对儿童进行骨内固定，不仅适用于有疼痛的患者，也适用于症状较轻的患者。所有患者Mayo肘关节功能评分均为良好及优秀，所有骨不连均愈合且活动范围良好。（2）儿童肱骨外侧髁骨折漏诊超过28个月会使Mayo功能评分降至89分以下。（3）术前出现AVN的病例，通过关节的一致性仍可取得良好效果并有重塑潜力。
