Lieber J, Dietzel M, Tsiflikas I, Schäfer J, Kirschner H-J, Fuchs J
Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
Abteilung für Diagnostische und Interventionelle Radiologie, Bereich Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
Unfallchirurg. 2019 May;122(5):345-352. doi: 10.1007/s00113-019-0605-0.
Fractures of the lateral humeral condyle with displacement (>2 mm; <2 mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive X‑rays.
A retrospective data analysis of all lateral humeral condyles in children <16 years old treated between 2005 and 2014 was carried out. The patients were classified according to the fracture stability at the time of the incident (primarily stable or unstable) and after 4 days (secondarily stable or unstable) using conventional X‑ray images.
A total of 89 fractures of the lateral humeral condyle were treated (mean age 6.4 years, range 0.9-14 years). Of the fractures 52 (58%) were initially not displaced and 37 (42%) were initially displaced. The latter underwent open reduction and stabilization by osteosynthesis (primarily stable). Of the 52 initially not displaced fractures 35 remained stable and conservative treatment in a plaster cast was performed (primarily and secondarily stable). In 8 out of 52 cases a secondary displacement (>2 mm articular gap) occurred after an average of 6 days (range 3-10 days) and operative treatment was initiated (primarily stable and secondarily unstable). No follow-up x‑ray could be performed in 2 of the 52 fractures and at the end of treatment the fractures healed with displacement (primarily stable and secondarily unstable). In 7 of the 52 fractures operative treatment was performed although no displacement (primarily stable) was initially documented (overtreatment). The outcome of the whole study cohort was comparable with that described in the literature.
Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with a stable osteosynthesis must be initiated.
肱骨外侧髁骨折伴移位（>2毫米；关节间隙<2毫米）需要切开复位并固定。无移位骨折应采取保守治疗；然而，区分完全性（潜在不稳定）和不完全性（稳定）关节骨折存在困难。本研究的目的是分析保守和手术治疗方法的频率，以及基于重复X线片显示的骨折稳定性的治疗决策准确性。
对2005年至2014年期间治疗的所有16岁以下儿童肱骨外侧髁骨折进行回顾性数据分析。使用传统X线图像，根据受伤时（主要稳定或不稳定）和4天后（继发稳定或不稳定）的骨折稳定性对患者进行分类。
共治疗89例肱骨外侧髁骨折（平均年龄6.4岁，范围0.9 - 14岁）。其中52例（58%）骨折最初无移位，37例（42%）最初有移位。后者通过骨固定进行切开复位并固定（主要稳定）。52例最初无移位的骨折中，35例保持稳定并采用石膏固定进行保守治疗（主要和继发稳定）。52例中有8例在平均6天（范围3 - 10天）后出现继发移位（关节间隙>2毫米）并开始手术治疗（主要稳定和继发不稳定）。52例骨折中有2例无法进行随访X线检查，治疗结束时骨折移位愈合（主要稳定和继发不稳定）。52例骨折中有7例尽管最初记录无移位（主要稳定）但仍进行了手术治疗（过度治疗）。整个研究队列的结果与文献中描述的结果相当。
儿童肱骨外侧髁骨折的治疗决策基于分期随访X线片中观察到的主要和继发骨折稳定性。稳定骨折，无论完全性或不完全性，保守治疗后愈合良好，可避免过度治疗。不稳定骨折，无论病程中是原发性还是继发性，都需要识别并开始采用稳定的骨固定进行手术治疗。
