Tuomilehto Noora, Kivisaari Reetta, Sommarhem Antti, Nietosvaara Aarno Y
a Helsinki University , Helsinki.
b Children's Hospital, Helsinki University Central Hospital , Helsinki , Finland.
Acta Orthop. 2017 Feb;88(1):109-115. doi: 10.1080/17453674.2016.1250058. Epub 2016 Oct 24.
Background and purpose - The quality of pin fixation of displaced supracondylar humerus fractures in children has not been assessed, and the clinical value of radiographic examinations after pin fixation is unclear. We evaluated pin configuration, quality of osteosynthesis, and outcome in 264 supracondylar fractures. The clinical significance of postoperative radiographs was analyzed. Patients and methods - 252 Gartland-III and 12 flexion-type supracondylar humerus fractures were pin-fixed in the periods 2002-2006 and 2012-2014. During 2012-2014, staff were intructed that postoperative radiographs should not be taken. Quality of reduction was assessed by measuring Baumann and lateral capitellohumeral angles (LCHA) and also by recording the crossing point of the anterior humeral line (AHL) with bony capitellum. Rotatory alignment was registered as normal or abnormal. Pin configuration and quality of osteosynthesis were evaluated. The clinical significance of postoperative radiographs was analyzed. Results - Postoperatively, Baumann angle was normal in 66% of the fractures, AHL crossed the capitellum in 84%, and no malrotation was evident in 85% of the fractures. Crossed pins were used in 89% of the cases. 2 or more pins fixed both fracture fragments in 66%. Radiographic examinations were inadequate for assessment of LCHA in 13%, of Bauman angle in 8%, of AHL in 2%, of rotation in 1%, and of pin fixation in 2% of the cases. Postoperative radiographs did not give useful information except in 1 patient who had corrective osteotomy. All 94 patients with follow-up (97%) who were treated during 2012-2014 were satisfied with the outcome. Interpretation - Despite pin fixation being deemed unsatisfactory in one-third of the cases, significant malunion was rare. Postoperative radiography did not alter management or outcome.
背景与目的——儿童移位性肱骨髁上骨折的克氏针固定质量尚未得到评估，克氏针固定后影像学检查的临床价值也不明确。我们评估了264例肱骨髁上骨折的克氏针构型、骨接合质量及预后情况，并分析了术后X线片的临床意义。患者与方法——252例Gartland-III型和12例屈曲型肱骨髁上骨折于2002年至2006年及2012年至2014年期间采用克氏针固定。在2012年至2014年期间，工作人员接到指示，术后不应拍摄X线片。通过测量鲍曼角和肱骨头外侧角（LCHA）以及记录肱骨前线（AHL）与肱骨小头的交叉点来评估复位质量。旋转对线记录为正常或异常。评估克氏针构型和骨接合质量，并分析术后X线片的临床意义。结果——术后，66%的骨折鲍曼角正常，84%的骨折AHL穿过肱骨小头，85%的骨折无明显旋转畸形。89%的病例使用了交叉克氏针。66%的病例用2根或更多克氏针固定骨折碎片。在13%的病例中，X线检查不足以评估LCHA，8%的病例中不足以评估鲍曼角，2%的病例中不足以评估AHL，1%的病例中不足以评估旋转情况，2%的病例中不足以评估克氏针固定情况。除1例行截骨矫正术的患者外，术后X线片未提供有用信息。2012年至2014年期间接受治疗的所有94例有随访记录（97%）的患者对预后满意。解读——尽管三分之一的病例中克氏针固定被认为不令人满意，但严重畸形愈合很少见。术后X线检查并未改变治疗方案或预后。
