Rinat Barak, Dujovny Eytan, Bor Noam, Rozen Nimrod, Rubin Guy
1 Orthopedic Department, Emek Medical Center, Afula, Israel.
2 Faculty of Medicine, Technion, Haifa, Israel.
J Int Med Res. 2019 Jan;47(1):133-141. doi: 10.1177/0300060518797022. Epub 2018 Sep 10.
High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce.
We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation.
Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann's angle and the carrying angle revealed no statistical difference between the two groups.
Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.
儿童肱骨髁上高位骨折通常采用闭合复位经皮穿针内固定治疗。若此方法失败，切开复位内固定则是广泛认可的首选治疗方法。近期有文献报道使用外侧外固定架作为一种可选治疗方法，但相关证据较少。
我们调查了采用切开复位内固定或闭合复位外固定治疗的上肢治疗效果。
21例患者完成长期随访；11例行切开复位，10例行外固定。两组中的大多数患者均表示非常满意。两组患者的改良上肢、肩部和手部功能障碍评分均极低，且平均肘关节活动范围几乎相同。通过鲍曼角和提携角进行的影像学分析显示两组之间无统计学差异。
对于复杂的不可复位肱骨髁上骨折，使用线性外固定架进行选择性治疗可产生与切开复位相当的可接受的临床和影像学结果。我们的样本量较小，但这些有前景的结果可能有助于实施替代手术方法，尤其是在涉及屈曲型骨折或严重软组织损伤及肿胀的更复杂病例中。
