Marengo Lorenza, Andreacchio Antonio, Alberghina Flavia, Dimeglio Alain, Canavese Federico
Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand.
Department of Pediatric Orthopedic Surgery, Regina Margherita Children's Hospital, Piazza Polonia Torino, Italy.
J Pediatr Orthop B. 2018 Mar;27(2):121-127. doi: 10.1097/BPB.0000000000000476.
The main aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcome of displaced intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH), the hypothesis being that intercondylar fractures have poorer functional outcome than do other upper-limb fractures. The mean age at the time of injury was 11.9±2.5 years (range: 7.5-15.8 years). The male-female ratio was 3.5 : 1. Using the Toniolo & Wilkins classification, 13 (72%) fractures were classified as type II and five (28%) as type III. The overall complication rate was 50%. The mean Quick DASH score was 9±11 (range: 0-31.8). Displaced intercondylar fractures of the humerus, although uncommon in skeletally immature patients, are characterized by poorer clinical and functional outcome compared with other pediatric humerus and elbow fractures. Minimally displaced fractures with articular surface displacement of less than 2 mm can be safely managed with closed reduction and percutaneous fixation, but any greater intra-articular displacement requires open reduction and internal fixation, which means a higher complication rate and poorer functional outcome should be expected, especially in patients older than 10 years.
本研究的主要目的是回顾性评估儿童和青少年肱骨髁间移位骨折的临床、功能和影像学结果,并使用上肢、肩部和手部功能障碍简化版问卷(Quick DASH)评估上肢功能,假设髁间骨折的功能结果比其他上肢骨折更差。受伤时的平均年龄为11.9±2.5岁(范围:7.5 - 15.8岁)。男女比例为3.5∶1。根据托尼奥洛和威尔金斯分类法,13例(72%)骨折被分类为Ⅱ型,5例(28%)为Ⅲ型。总体并发症发生率为50%。Quick DASH平均评分为9±11(范围:0 - 31.8)。肱骨髁间移位骨折在骨骼未成熟患者中虽不常见,但与其他儿童肱骨和肘部骨折相比,其临床和功能结果较差。关节面移位小于2毫米的轻度移位骨折可通过闭合复位和经皮固定安全处理,但任何更大的关节内移位都需要切开复位和内固定,这意味着并发症发生率更高,功能结果更差,尤其是在10岁以上的患者中。