Roberts Lauren, Strelzow Jason, Schaeffer Emily K, Reilly Christopher W, Mulpuri Kishore
Department of Orthopaedics, University of British Columbia.
Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC.
J Pediatr Orthop. 2018 Nov/Dec;38(10):521-526. doi: 10.1097/BPO.0000000000000863.
Although the recommended treatment for Gartland types I and III supracondylar humeral fractures is well-established, the optimal treatment for type II fractures without rotational malalignment remains controversial, involving circumferential casting or closed reduction and pinning. Our institution uses pronated flexion-taping for Gartland type IIA fractures. This theoretically removes external pressure secondary to circumferential casting, potentially decreasing risks of compartment syndrome and mitigating loss of reduction with extension while maintaining optimal flexion position for reduction. To our knowledge, these modalities have not yet been compared.
A retrospective chart review was performed to compare flexion-taping with cuff-and-collar immobilization versus traditional above-elbow casting at 90 to 100 degrees. It was hypothesized that closed reduction and flexion-taping of type IIA supracondylar fractures under sedation in the emergency department would result in comparable, if not superior, maintenance of reduction measured radiographically using Baumann angle and the lateral humeral capitellar angle (LHCA). Charts from 2010 to 2015 were reviewed for all patients between 2 and 8 years of age with type IIA fractures treated with cast or taping.
A total of 39 patients were included with 16 in the cast group and 23 in the tape group. Mean age was 4.08±1.72 years across both groups. No significant change in either measure was seen at termination of immobilization (3 to 4 wk postreduction). Final lateral humeral capitellar angle in the taping group was 32.14±5.90 degrees compared with 28.23±7.27 degrees in the casting group (P=0.81). Final Baumann angle was 73.41±4.03 degrees in the taping group compared with 73.75±6.46 degrees (P=0.96). The only complication was a self-limiting rash experienced by 1 patient in the taping group.
Both techniques were able to achieve and maintain adequate reduction in all cases with no significant difference in outcome measures. There were no major complications or conversions to surgical treatment. In this cohort, taping resulted in adequate reduction and safe immobilization for type IIA fractures comparable to cast immobilization. Further research will investigate clinical/radiographic outcomes on these patients to assess remodeling and function.
Level III-retrospective comparative study.
虽然肱骨髁上骨折Gartland I型和III型的推荐治疗方法已确立，但无旋转畸形的II型骨折的最佳治疗方法仍存在争议，涉及环形石膏固定或闭合复位穿针固定。我们机构对Gartland IIA型骨折采用旋前屈肘贴扎法。从理论上讲，这消除了环形石膏固定产生的外部压力，潜在地降低了骨筋膜室综合征风险，并在维持最佳屈曲复位位置的同时减轻了伸直位复位丢失的情况。据我们所知，尚未对这些方法进行比较。
进行一项回顾性图表审查，以比较屈肘贴扎法与袖带颈腕固定法和90至100度传统上臂石膏固定法。假设在急诊科镇静下对IIA型髁上骨折进行闭合复位和屈肘贴扎法，使用鲍曼角（Baumann angle）和肱骨小头外侧角（LHCA）进行影像学测量，其复位维持效果即使不优于传统方法，也至少相当。回顾了2010年至2015年所有2至8岁接受石膏或贴扎治疗的IIA型骨折患者的图表。
共纳入39例患者，石膏组16例，贴扎组23例。两组平均年龄为4.08±1.72岁。固定结束时（复位后3至4周），两项测量指标均无显著变化。贴扎组最终肱骨小头外侧角为32.14±5.90度，而石膏组为28.23±7.27度（P = 0.81）。贴扎组最终鲍曼角为73.41±4.03度，石膏组为73.75±6.46度（P = 0.96）。唯一的并发症是贴扎组1例患者出现自限性皮疹。
两种技术在所有病例中均能实现并维持充分复位，结果指标无显著差异。无重大并发症，也无需转为手术治疗。在该队列中，贴扎法对于IIA型骨折能实现充分复位并安全固定，与石膏固定相当。进一步研究将调查这些患者的临床/影像学结果，以评估重塑和功能情况。
III级——回顾性比较研究。
