Dabash Sherif, Gerzina Chris, Prabhakar Gautham, Thabet Ahmed M, Jeon Soyoung, Heinrich Stephen D
Orthopaedics Department, University of Texas Health Science Center at Houston, Houston, USA.
Orthopaedics Department, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Eur J Orthop Surg Traumatol. 2019 Apr;29(3):575-581. doi: 10.1007/s00590-018-2316-6. Epub 2018 Oct 17.
Supracondylar fractures in the pediatric population are common. For years, K-wires have been the preferred method of surgical fixation. However, fixation with K-wires alone may lead to multiple complications. This study reports the results of surgical care of supracondylar humerus fractures using screw fixation with K-wires or screw fixation alone.
This study retrospectively reviewed all patients with supracondylar humerus fractures treated with screw fixation between 2007 and 2013. Patients treated only with smooth wires, or having a displaced medial epicondyle, or presenting with lateral condyle fractures were excluded from the study. Flynn's criteria were used to determine the outcome.
Seventeen patients who met inclusion criteria formed the study group. All patients were followed until union, resolution of complications, and return to preinjury activity level. Satisfactory outcome was reported in 70.6% of patients with less than 15° loss of either flexion or extension. Mean time to union was 6.5 weeks (range 3.3-12.1 weeks). Screw fixation alone had a shorter mean time to union (5.5 weeks) than compared screw fixation with K-wires group (6.9 weeks). Full range of motion following surgical invention was associated with Flynn's criteria (p value = 0.044).
Screw fixation for pediatric supracondylar fractures is a viable option to achieve healing and early motion in highly unstable fractures as well as fractures which require (1) increased stability, (2) maintenance of stability during wound checks in the immediate postoperative period and after discontinuation of the cast, or (3) if further exploration like associated vascular injury is warranted.
小儿髁上骨折很常见。多年来，克氏针一直是手术固定的首选方法。然而，单纯使用克氏针固定可能会导致多种并发症。本研究报告了使用克氏针螺钉固定或单纯螺钉固定治疗肱骨髁上骨折的手术疗效。
本研究回顾性分析了2007年至2013年间所有接受螺钉固定治疗的肱骨髁上骨折患者。仅接受光滑钢丝治疗、有内侧髁移位或伴有外侧髁骨折的患者被排除在研究之外。采用弗林标准来确定治疗结果。
17名符合纳入标准的患者组成了研究组。所有患者均随访至骨折愈合、并发症解决并恢复到伤前活动水平。在屈伸活动度丧失均小于15°的患者中，70.6%报告了满意的治疗结果。平均愈合时间为6.5周（范围3.3 - 12.1周）。单纯螺钉固定组的平均愈合时间（5.5周）比克氏针螺钉固定组（6.9周）短。术后获得的全关节活动度与弗林标准相关（p值 = 0.044）。
对于小儿髁上骨折，螺钉固定是一种可行的选择，可实现高度不稳定骨折以及需要（1）增强稳定性、（2）在术后即刻伤口检查期间及拆除石膏后维持稳定性、或（3）如果需要进一步探查如合并血管损伤等情况下骨折的愈合和早期活动。
