青少年移位性内上髁骨折的固定
Fixation of Displaced Medial Epicondyle Fractures in Adolescents.
作者信息
Pace Gregory I, Hennrikus William L
机构信息
Pennsylvania State College of Medicine, Hershey, PA.
出版信息
J Pediatr Orthop. 2017 Mar;37(2):e80-e82. doi: 10.1097/BPO.0000000000000743.
BACKGROUND
Open reduction and internal fixation of displaced medial epicondyle fracture dislocations in adolescents is recommended for incarceration of the epicondyle in the joint and for athletes who need a stable elbow for their sport. A screw placed across the epicondyle into the medial column avoiding the olecranon fossa is a common fixation method. One author has recommended adding a metal washer to the screw fixation because of the perceived risk of epicondyle fragmentation or penetration when using a screw alone. The purpose of this study was to determine whether the use of a screw and washer for the fixation of pediatric medial epicondyle fractures results in less fragmentation of the epicondyle at the time of surgery and more complaints of hardware prominence leading to a second surgery to remove a deep implant.
METHODS
A retrospective review was performed of patients treated surgically for displaced medial epicondyle fracture dislocations between 2008 and 2014.
RESULTS
Sixteen patients with a total of 17 fracture dislocations were included in the study. The average follow-up was 11.5 months. Twelve fractures were treated with a screw and washer and 5 fractures were treated with a screw alone. All fractures healed. No fracture treated with a screw alone resulted in fragmentation or penetration of the epicondyle fragment. Seven of 12 patients treated with a screw and washer requested deep metal removal due to prominence and irritation at the medial epicondyle. No patient treated with a screw alone requested metal removal (58% vs. 0%; P=0.04).
CONCLUSIONS
One author suggested that adding a washer to the screw for fixation of medial epicondyle fractures improved the ability to safely compress the fragment. However, the results of the present study report no case of fragmentation or penetration of the epicondyle when a washer was not used. In addition, the use of a screw and washer significantly increased the likelihood of a second surgery for removal of prominent hardware.
LEVEL OF EVIDENCE
Level IV.
背景
对于青少年移位性内上髁骨折脱位，若内上髁嵌入关节或运动员因运动需要稳定的肘部，建议行切开复位内固定术。一种常见的固定方法是在内上髁置入螺钉至内侧柱，避开鹰嘴窝。有一位作者建议在螺钉固定时增加一个金属垫圈，因为单独使用螺钉时存在内上髁骨折块碎裂或穿透的风险。本研究的目的是确定使用螺钉和垫圈固定小儿内上髁骨折在手术时是否能减少内上髁骨折块的碎裂，以及是否会增加因内固定物突出导致的不适主诉，进而需要二次手术取出深部植入物。
方法
对2008年至2014年间接受手术治疗的移位性内上髁骨折脱位患者进行回顾性研究。
结果
本研究共纳入16例患者，总计17例骨折脱位。平均随访时间为11.5个月。12例骨折采用螺钉加垫圈治疗，5例骨折仅采用螺钉治疗。所有骨折均愈合。仅采用螺钉治疗的骨折未出现内上髁骨折块碎裂或穿透。12例采用螺钉加垫圈治疗的患者中有7例因内上髁处内固定物突出和刺激要求取出深部金属植入物。仅采用螺钉治疗的患者中无人要求取出金属植入物（58%对0%；P = 0.04）。
结论
有一位作者认为在内上髁骨折固定时增加垫圈可提高安全加压骨折块的能力。然而，本研究结果显示未使用垫圈时未出现内上髁骨折块碎裂或穿透的病例。此外，使用螺钉和垫圈显著增加了因内固定物突出而进行二次手术取出的可能性。
证据级别
四级。
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