Orthopaedic Surgery, Borders General Hospital, Huntlyburn Melrose TD6 9BS, Scotland, UK.
Orthopaedic surgery, Yeovil Hospital, Higher Kingston Yeovil BA21 4AT, Somerset, UK.
Orthop Traumatol Surg Res. 2019 Jun;105(4):739-745. doi: 10.1016/j.otsr.2019.03.007. Epub 2019 Apr 19.
Displaced lateral humeral condyle fractures in children are usually treated with open reduction and internal fixation. When treated operatively with Kirschner wires, the bent cut near side wire ends are either buried in the subcutaneous tissue or are left exposed. It is believed that burying the wires allows them to remain in longer and hence facilitate better union. Leaving them exposed seems to necessitate earlier removal, especially to reduce the risk of wire tract infection. There is not a clear consensus in published literature whether subcutaneous wire burial is better or not.
A systematic review of literature was performed using online database EMBASE, Pubmed, Medline, CINAHL and Cochrane database. The inclusion criteria comprised only those studies that compared lateral humeral condyle fracture fixation in children with wires buried subcutaneously versus those left exposed to skin.
Of the four studies identified, three reported that it was safe to leave the wires exposed and that there was no statistically significant advantage of burying the wires with regards to risk of infection. However, our meta-analysis of the four studies demonstrated on forest plot charts that there is an increased risk of infection when the wires are left exposed (odds ratio 0.538 CI 0.437-0.639), but the overall complication rate was less in the group treated with exposed wires. Treatment with exposed wires was also cost effective when compared to treatment with buried wires.
Our review concluded that despite a higher risk of superficial infections, exposed wires are safe and an economical option when fixing lateral humeral condyle fractures in children.
II, systematic review.
儿童移位性肱骨外髁骨折通常采用切开复位内固定治疗。当使用克氏针进行手术治疗时，弯曲的近端线末端要么埋入皮下组织，要么暴露在外。人们认为将线材掩埋可以使其保持更长时间，从而促进更好的愈合。将它们暴露在外似乎需要更早地移除，尤其是为了降低线材轨迹感染的风险。在已发表的文献中，没有明确的共识表明皮下线材掩埋是否更好。
我们使用在线数据库 EMBASE、Pubmed、Medline、CINAHL 和 Cochrane 数据库进行了文献系统评价。纳入标准仅包括那些比较儿童肱骨外髁骨折固定时将线材皮下掩埋与暴露于皮肤的研究。
在确定的四项研究中，有三项研究报告说暴露线材是安全的，并且在感染风险方面，将线材掩埋没有统计学上的优势。然而，我们对四项研究的荟萃分析表明，当暴露线材时，感染的风险会增加（比值比 0.538 CI 0.437-0.639），但暴露线材治疗组的总体并发症发生率较低。与埋入线材治疗相比，暴露线材治疗在经济上也更具优势。
我们的综述得出结论，尽管存在更高的浅表感染风险，但暴露线材在治疗儿童肱骨外髁骨折时是安全且经济的选择。
II，系统评价。
