Tomori Yuji, Sudo Yoshihiro, Iizawa Norishige, Nanno Mitsuhiko, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan.
Medicine (Baltimore). 2017 Feb;96(6):e6085. doi: 10.1097/MD.0000000000006085.
Intercondylar fracture of the distal humerus is an extremely rare injury in children, especially in those under 8 years of age. To our best knowledge, there have been 55 reported cases of this fracture type in children in the English literature, 12 of which involved children under 8 years of age.
We report a case of intercondylar fracture of the distal humerus in a7-year-old boy fell in a gymnasium, injuring his left elbow.
Closed reduction was initially attempted under fluoroscopic guidance, but anatomic reduction could not be achieved because the fragments were extremely unstable and irreducible. Considering the displacement and the failure of closed reduction, ORIF through a posterior approach was performed. Open reduction and double cross-pinning across the medial and lateral condylar fragments were performed through a posterior approach.
Plain radiographs showed a displaced intercondylar fracture of the distal humerus. Arthrography under general anesthesia showed a severely displaced intra-articular fracture, with rotational displacement of the lateral condyle.
Thirteen months after surgery, there was no functional disturbance or radiographic evidence of avascular necrosis or epiphyseal growth arrest.
Open reduction and double cross-pinning through a posterior approach can be a reliable procedure for intercondylar fracture of the distal humerus in children.
肱骨远端髁间骨折在儿童中极为罕见,尤其是8岁以下儿童。据我们所知,英文文献中报道的儿童该类型骨折病例有55例,其中12例涉及8岁以下儿童。
我们报告一例7岁男孩在体育馆摔倒致左肘部受伤,诊断为肱骨远端髁间骨折。
最初尝试在透视引导下进行闭合复位,但由于骨折块极不稳定且无法复位,未能实现解剖复位。考虑到骨折移位及闭合复位失败,遂采用后入路切开复位内固定术。通过后入路对内侧和外侧髁间骨折块进行切开复位及双交叉克氏针固定。
X线平片显示肱骨远端髁间骨折移位。全身麻醉下关节造影显示关节内骨折严重移位,外侧髁有旋转移位。
术后13个月,无功能障碍,也无缺血性坏死或骨骺生长停滞的影像学证据。
后入路切开复位及双交叉克氏针固定术对于儿童肱骨远端髁间骨折可能是一种可靠的手术方法。