Patel Neeraj M, Gajewski Christopher R, Ascoli Anthony M, Lawrence J Todd R
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Pediatr Orthop B. 2019 Nov;28(6):526-529. doi: 10.1097/BPB.0000000000000655.
The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Of the 137 patients included in the study, a washer was utilized in 90 (66%). Thirty-one patients (23%) ultimately underwent hardware removal. There was not an increased need for implant removal in those with a washer (P = 0.11). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (P = 0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9 ± 9.7 weeks after surgery with no significant difference along the lines of washer use. Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of medial epicondyle fractures, even in athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.
在小儿内上髁骨折的手术治疗中，使用垫圈辅助螺钉固定可防止骨折块碎裂和螺钉穿出。然而，可能会出现对螺钉突出以及后续取出植入物必要性的担忧。本研究的目的是评估使用垫圈对取出内固定物的必要性以及肘关节活动范围（ROM）的影响。本回顾性病例对照研究查询了在7年期间所有采用单枚螺钉治疗的小儿内上髁骨折病例。仅当患者出现并发症或与植入物相关的症状且非手术治疗无效时才进行内固定物取出。在纳入研究的137例患者中，90例（66%）使用了垫圈。31例患者（23%）最终进行了内固定物取出。使用垫圈的患者中取出植入物的必要性并未增加（P = 0.11）。仅分析102例运动员亚组时，使用垫圈与否在植入物取出率方面同样没有差异（P = 0.64）。总体而言，107例（78%）患者在术后平均13.9±9.7周恢复了完全的活动范围，使用垫圈与否并无显著差异。即使在运动员中，使用垫圈也不会影响内上髁骨折固定后取出植入物的必要性或肘关节活动范围。如果担心骨折块碎裂或螺钉穿出，可使用垫圈，而无需担心未来可能需要进行计划外手术。
