Gera S K, Tan McH, Lim Y G, Lim Kbl
Department of Orthopaedics, KK Women's and Children's Hospital, Singapore.
Malays Orthop J. 2017 Jul;11(2):40-44. doi: 10.5704/MOJ.1707.017.
This study aims to ascertain if there are any differences in supracondylar fractures between children under seven years of age and those above 7 years of age. All cases of displaced humerus supracondylar fractures that required surgical stabilization were identified and retrospectively reviewed. Demographic data, mode of injury, associated neurovascular injuries and details of surgery performed were obtained from clinical records. The Gartland classification and the extent of comminution of fractures were also documented from review of radiographs. One hundred and twelve children were included in this study, of whom 61 (54.46%) were younger than seven years of age while 51 (45.5%) were aged seven years or older. Children aged seven or older had a greater incidence of associated neurological deficit at presentation (p=0.046). Of the six patients with nerve injury in the older age group, one patient (16.7%) had a radial nerve injury, two patients (33.3%) had ulnar nerve injuries while another two patients (33.3%) had median nerve injuries. There was one patient (16.7%) with both median and ulnar nerve injuries. Comminuted fractures were also more common in the older children (p=0.004). No significant differences were demonstrated between the groups with regard to age, gender and mechanism of injury, laterality, incidence of open fracture, vascular injuries and operative time. Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures. There is also a higher incidence of associated neurological injury. These cases must be carefully examined for at presentation and parents need to be appropriately counselled about them.
本研究旨在确定7岁以下儿童与7岁以上儿童的肱骨髁上骨折是否存在差异。所有需要手术固定的移位肱骨髁上骨折病例均被识别并进行回顾性分析。从临床记录中获取人口统计学数据、损伤方式、相关神经血管损伤以及手术细节。通过复查X线片记录Gartland分型和骨折粉碎程度。本研究纳入了112名儿童，其中61名（54.46%）年龄小于7岁，51名（45.5%）年龄为7岁或以上。7岁及以上儿童就诊时合并神经功能缺损的发生率更高（p = 0.046）。在年龄较大的儿童组中6例神经损伤患者中，1例（16.7%）为桡神经损伤，2例（33.3%）为尺神经损伤，另外2例（33.3%）为正中神经损伤。有1例（16.7%）患者正中神经和尺神经均损伤。粉碎性骨折在年龄较大的儿童中也更常见（p = 0.004）。两组在年龄、性别、损伤机制、骨折侧别、开放性骨折发生率、血管损伤和手术时间方面未显示出显著差异。肱骨髁上骨折的7岁及以上儿童往往骨折粉碎更严重。合并神经损伤的发生率也更高。这些病例在就诊时必须仔细检查，并且需要向家长进行适当的咨询。
