Prakash Jatin, Mehtani Anil
Department of Orthopaedics, Safdarjung Hospital and Vardhman Mahavir Medical College.
Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
J Pediatr Orthop B. 2018 Mar;27(2):134-141. doi: 10.1097/BPB.0000000000000443.
The management of neglected fracture of the lateral condyle of the humerus is controversial. Careful neglect and conservative management with early ulnar nerve transposition and ostetomy, in-situ surgical fixation and accurate open reduction and internal fixation are all recommended as treatment options. However, an overgrowth of fractured condyle, highly distorted anatomy, contracted soft tissue and almost unrecognizable fracture ends make open reduction a challenging task. As the functional loss is not severe, in-situ fixation of the fragment provides a good alternative. There have been proponents of both surgeries with very limited data on comparison on both procedures. Here, we present our experience of 45 patients, 22 treated with anatomical reduction and 23 treated with in-situ fixation with no attempts of anatomical restoration, and attempted to evaluate the results of two surgeries with a follow-up of at least 2 years. Neglected fractures of the lateral condyle were surgically treated with two different techniques. In all, 22 patients were treated with open reduction and fixation whereas 23 patients were treated with in-situ fixation to render the elbow stable. Patients were followed for a minimum of 2 years. These patients were studied in terms of functional scores and radiological union. Radiological union was better in the anatomical reduction group with one nonunion compared with five in the in-situ group. However, functional results and elbow range were better in the in-situ fixation group. The surgical time was 57 min in in-situ fixation compared with 73 min in the anatomical reduction group. Complication rates were found to be high in the open reduction group. In-situ fixation of neglected lateral condyle fractures is an effective technique for the treatment of these difficult fractures presenting late compared with anatomical fixation. Radiological union, although less successful compared with open anatomical reduction, leads to better functional outcome, with decreased surgical time and postoperative complications.
肱骨外侧髁陈旧性骨折的治疗存在争议。有人建议采取谨慎的保守治疗，早期进行尺神经移位和截骨术，也有人建议进行原位手术固定以及精确的切开复位内固定，这些都是可供选择的治疗方法。然而，骨折髁过度生长、解剖结构严重扭曲、软组织挛缩以及骨折端几乎无法辨认，使得切开复位成为一项具有挑战性的任务。由于功能丧失并不严重，骨折块原位固定是一个不错的选择。两种手术方式都有支持者，但关于两者比较的数据非常有限。在此，我们介绍45例患者的治疗经验，其中22例接受解剖复位治疗，23例接受原位固定治疗，未尝试进行解剖复位，并试图对这两种手术方式进行至少2年的随访评估。肱骨外侧髁陈旧性骨折采用两种不同技术进行手术治疗。总共22例患者接受切开复位内固定治疗，而23例患者接受原位固定以使肘关节稳定。对患者进行了至少2年的随访。从功能评分和影像学愈合方面对这些患者进行了研究。解剖复位组的影像学愈合情况较好，有1例骨不连，而原位固定组有5例。然而，原位固定组的功能结果和肘关节活动范围更好。原位固定的手术时间为57分钟，而解剖复位组为73分钟。切开复位组的并发症发生率较高。与解剖固定相比，肱骨外侧髁陈旧性骨折的原位固定是治疗这些晚期出现的复杂骨折的有效技术。尽管与切开解剖复位相比，影像学愈合成功率较低，但能带来更好的功能结果，同时减少手术时间和术后并发症。
