Chaturvedi Hemant, Khanna Vikram, Bhargava Rakesh, Vaishya Raju
Department of Orthopaedics, National Institute of Medical Sciences, Jaipur, India.
Department of Orthopaedics, Ranjana Hospital, Allahabad, India.
J Clin Orthop Trauma. 2018 Mar;9(Suppl 1):S92-S96. doi: 10.1016/j.jcot.2017.10.009. Epub 2017 Oct 31.
Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb.
MATERIALS & METHODS: Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria.
Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score.
Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.
在与小儿肱骨髁上骨折相关的所有并发症中，仅1%的病例报告有严重血管损伤，其中不到1%会发展为Volkmann缺血性挛缩。本研究评估了诸如损伤就诊延迟、肢体灌注和脉搏等因素在确定无脉肢体的肱骨髁上骨折功能结局中的作用。
纳入2012年至2014年出现的21例无脉肱骨髁上骨折的小儿患者。患者分为3组，A组（复位后脉搏恢复，n = 13），B组（手部无脉但呈粉红色，n = 7）和C组（手部无脉且呈白色，n = 1）。A组11例患者和B组4例患者在受伤后6小时内就诊，其余患者在6小时后就诊。主要结局是桡动脉搏动和灌注所表明的血管状况，次要结局包括用Mayo肘关节功能评分和Flynn标准评估的功能参数。
A组患者的平均外周血氧饱和度高于B组，C组的血氧饱和度无法记录。A组的平均毛细血管再充盈时间比B组更长，而C组患者皮肤苍白，未见毛细血管再充盈。与B组和C组相比，A组患者的平均Mayo肘关节功能评分最高。受伤后6小时内就诊的患者的平均Mayo肘关节功能评分高于受伤后6小时后就诊的患者。根据Flynn标准测量，13例患者的功能结局为优。6例患者为良，2例为中。受伤时间与Mayo肘关节功能评分之间存在中度负相关（R = -0.5798）。
受伤至就诊的时间、肢体灌注和外周脉搏的存在似乎是决定无脉肱骨髁上骨折结局的重要预测因素。
