Marengo Lorenza, Rousset Marie, Paonessa Matteo, Vanni Stefania, Dimeglio Alain, Samba Antoine, Andreacchio Antonio, Canavese Federico
Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
Pediatric Orthopedic Surgery Department, Regina Margherita Children's Hospital, Turin, Italy.
Eur J Orthop Surg Traumatol. 2016 Jul;26(5):453-9. doi: 10.1007/s00590-016-1758-y. Epub 2016 Mar 17.
The objectives of this study were to retrospectively investigate the clinical and radiological outcome of humeral shaft fractures treated by ESIN in children <16 years old and to evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH(®)).
We retrospectively evaluated children with fractures of the humeral shaft, surgically treated by ESIN. All the patients were regularly followed clinically and radiographically for at least 1 year after their index surgery. After hardware removal, the patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH).
Thirty-eight patients met the inclusion criteria. Mean age at the time of trauma was 11.1 years. Mean follow-up was 30 months. All fractures healed, but three patients had a residual valgus of >10°, two a residual varum of >10°, four a residual recurvatum deformity of >10°, and one a residual procurvatum deformity of >10°. Four complications were observed. Functional outcome was nevertheless good in all the patients, with a mean Quick DASH(®) score of 3.
The study shows good clinical and functional outcomes in children and adolescents with closed isolated fractures of the humeral shaft surgically treated by ESIN, even with ensuing mild residual frontal and sagittal plane deformity. However, conservative treatment has also been advocated in the scientific literature for this type of injuries, and surgical treatment should not be considered as the only option for the management of humeral shaft fractures in older children and adolescents.
本研究的目的是回顾性调查年龄小于16岁的儿童肱骨干骨折采用弹性髓内钉固定（ESIN）治疗后的临床和放射学结果，并使用上肢、肩部和手部功能障碍结局问卷简版（Quick DASH(®)）评估这些损伤的功能结局。
我们回顾性评估了采用ESIN手术治疗的肱骨干骨折患儿。所有患者在初次手术后均接受了至少1年的定期临床和影像学随访。取出内固定装置后，要求患者回答上肢、肩部和手部功能障碍结局问卷简版（Quick DASH）。
38例患者符合纳入标准。受伤时的平均年龄为11.1岁。平均随访时间为30个月。所有骨折均愈合，但3例患者残留外翻>10°，2例残留内翻>10°，4例残留后凸畸形>10°，1例残留前凸畸形>10°。观察到4例并发症。然而，所有患者的功能结局均良好，平均Quick DASH(®)评分为3分。
该研究表明，对于采用ESIN手术治疗的儿童和青少年闭合性孤立肱骨干骨折，即使随后出现轻度残留额状面和矢状面畸形，临床和功能结局也良好。然而，科学文献中也提倡对这类损伤采用保守治疗，手术治疗不应被视为大龄儿童和青少年肱骨干骨折治疗的唯一选择。
