Segal David, Cobb Leah, Little Kevin J
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Affiliated with Cincinnati University, Cincinnati, Ohio, USA.
Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with Tel Aviv University, Kfar Saba, Israel.
J Pediatr Orthop B. 2020 Mar;29(2):105-116. doi: 10.1097/BPB.0000000000000636.
Supracondylar humeral fractures in older children have different biomechanical characteristics and surgical outcomes when compared to the same fractures in younger children. We aimed to analyze the fracture's architecture in a large group of older children and investigate the correlation between patients' variables, fracture patterns, fixation techniques and the rate of loss of reduction (LOR). A retrospective review study was conducted. We collected the records of 240 consecutive patients aged 8-14 years that sustained Gartland type 2/3 supracondylar humeral fractures between 2004 and 2014 and were operated at our hospital. We excluded patients with intra-articular or pathological fractures. Following the radiographical analysis and chart review, we conducted a multivariable regression analysis. Fracture obliquity on the sagittal plane ( > 20°) occurred in 33% of the cases and was found to be the only factor related to LOR (P = 0.01). Gartland type 3 fractures and more than two lateral pin configuration did not correlate to fixation failure (P = 0.69 and 0.14, respectively). The incidence of flexion-type fractures (5.8%) was found to be higher than in the total pediatric population. The sagittal oblique supracondylar humeral fracture is common and is related to fixation instability and LOR. This pattern needs to be considered when investigating different pin configurations, complication rates, and biomechanical properties. Subclassifying Gartland type 2/3 supracondylar humeral fractures as 'oblique' or 'transverse' might offer more comprehensive information about the anticipated operative results, lead to applying more stable pin constructs to these fractures and allow improved outcomes following surgical fixation.
与年幼儿童的肱骨髁上骨折相比，大龄儿童的肱骨髁上骨折具有不同的生物力学特征和手术结果。我们旨在分析一大组大龄儿童骨折的结构，并研究患者变量、骨折类型、固定技术与复位丢失率（LOR）之间的相关性。进行了一项回顾性研究。我们收集了2004年至2014年间在我院接受手术的240例年龄在8至14岁之间、发生Gartland 2/3型肱骨髁上骨折的连续患者的记录。我们排除了关节内或病理性骨折患者。在进行影像学分析和病历审查后，我们进行了多变量回归分析。矢状面骨折倾斜度（>20°）在33%的病例中出现，并且被发现是与LOR相关的唯一因素（P = 0.01）。Gartland 3型骨折和超过两根外侧针的配置与固定失败无关（分别为P = 0.69和0.14）。屈曲型骨折的发生率（5.8%）高于整个儿童人群。矢状面斜形肱骨髁上骨折很常见，并且与固定不稳定和LOR有关。在研究不同的针配置、并发症发生率和生物力学特性时需要考虑这种类型。将Gartland 2/3型肱骨髁上骨折细分为“斜形”或“横行”可能会提供有关预期手术结果的更全面信息，导致对这些骨折应用更稳定的针结构，并改善手术固定后的结果。
