Thévenin-Lemoine C, Salanne S, Pham T, Accadbled F, Baunin C, Sales De Gauzy J
Pediatric Orthopaedics Department, hôpital des Enfants, 49, rue Bernadette, 31100 Toulouse, France.
Emergency Care Department, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
Orthop Traumatol Surg Res. 2017 Sep;103(5):777-781. doi: 10.1016/j.otsr.2017.04.008. Epub 2017 May 30.
The treatment for non-displaced (<2 mm displacement) fractures of the lateral humeral condyle in children is controversial. Most studies recommend non-surgical treatment. However, plain radiographs are not sufficient to evaluate extension of the fracture line through the articular cartilage. This explains the high frequency of secondary displacements and non-unions, despite well-conducted conservative treatment. We hypothesized that MRI could be used to analyse whether the fracture is complete or incomplete. This could help to determine whether surgical or conservative treatment is indicated.
This prospective study enrolled children being treated for a non-displaced (< 2 mm gap) fracture of the lateral humeral condyle. All patients were treated with a long-arm cast in the emergency room. An MRI was done later on without sedation. A specific protocol was used to reduce the duration of the examination. T2-weighted and proton density fat-saturated sequences were used.
Twenty-seven patients were enrolled: 16 boys and 11 girls with a mean age of 5 years (2-10). The MRI was performed an average of 7 days (1-23) after the fracture. The MRI could not be interpreted in two cases because the child had moved during the examination. In the other 25 patients, the fracture was incomplete in 17 patients and complete in 8 patients. Two children had secondary displacement diagnosed 7 and 11 days after the fracture event. These two patients underwent open reduction and internal fixation. There was no correlation between patient age and the fracture being complete or incomplete. There were no cases of non-union.
MRI appears to be a reliable method for determining whether the fracture line is complete or incomplete. It can be performed without sedation, even in children as young as 2 years of age. Use of an injury-specific MRI protocol reduces the length of the examination, thereby improving its performance. We recommend that it be used to analyse non-displaced fractures of the lateral humeral condyle in children.
3 Prospective study.
儿童肱骨外侧髁无移位（移位<2毫米）骨折的治疗存在争议。大多数研究推荐非手术治疗。然而，普通X线片不足以评估骨折线通过关节软骨的延伸情况。这就解释了为何尽管进行了良好的保守治疗，二次移位和骨不连的发生率仍很高。我们推测磁共振成像（MRI）可用于分析骨折是完全性还是不完全性的。这有助于确定是采用手术治疗还是保守治疗。
这项前瞻性研究纳入了因肱骨外侧髁无移位（间隙<2毫米）骨折而接受治疗的儿童。所有患者在急诊室均采用长臂石膏固定。随后在未使用镇静剂的情况下进行MRI检查。采用特定方案以缩短检查时间。使用了T2加权和质子密度脂肪饱和序列。
共纳入27例患者：16例男孩和11例女孩，平均年龄5岁（2 - 10岁）。MRI检查平均在骨折后7天（1 - 23天）进行。有2例因患儿在检查过程中移动而无法对MRI结果进行解读。在其他25例患者中，17例骨折为不完全性，8例为完全性。有2名儿童在骨折事件发生后7天和11天被诊断为二次移位。这两名患者接受了切开复位内固定术。患者年龄与骨折为完全性或不完全性之间无相关性。无骨不连病例。
MRI似乎是确定骨折线是完全性还是不完全性的可靠方法。即使对于年仅2岁的儿童，也可在不使用镇静剂的情况下进行。采用针对损伤的MRI方案可缩短检查时间，从而提高其效能。我们建议将其用于分析儿童肱骨外侧髁无移位骨折。
3级前瞻性研究。
