Shrestha Shilu, Hutchison Richard L
Kirtipur Hospital, Phect-Nepal, Kathmandu, Nepal.
BRCA/Blake Medical Centre, 2020 59th St W, Bradenton, FL, 34209, USA.
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):251-258. doi: 10.1016/j.jcot.2019.09.012. Epub 2019 Sep 12.
Fractures of lateral condyle of humerus are very common in children. While the management of acute displaced and rotated lateral condyle fracture of humerus with early open reduction and internal fixation yields good results, the results of late treatment are less clear. We conducted this study to analyse the results of operative treatment of late presenting fractures and see if it is dependent on the patient's age, fracture type, or the time until treatment.
MATERIALS & METHODS: A retrospective study of 40 patients with a symptomatic lateral condyle fracture beyond 3 weeks, who underwent open reduction and internal fixation between January 2002 and December 2011, was conducted. Fractures were described as per Jakob's classification. Patients radiographs were evaluated, and clinical evaluation was done with Mayo elbow scoring and Dhillon scoring system as well as range of motion.
Thirty-nine fractures united with average time of 7.8 weeks except one who had previous surgery done for the fracture and developed avascular necrosis. The average Mayo score was 93 and average Dhillon score was 7.6. The average improvement in the arc of motion was 40.32° (77.3-117.6°). Younger age and shorter time to operation had a statistically significant but weak effect on outcomes.
Functional outcomes of fractures managed surgically revealed good results, even in the fractures presenting more than 12 weeks after injury. Families with children presenting late should be offered ORIF to improve function and decrease symptoms.
肱骨外侧髁骨折在儿童中非常常见。虽然早期切开复位内固定治疗急性移位和旋转的肱骨外侧髁骨折效果良好，但晚期治疗的结果尚不清楚。我们进行这项研究以分析晚期出现骨折的手术治疗结果，并探讨其是否取决于患者年龄、骨折类型或治疗延迟时间。
对2002年1月至2011年12月期间接受切开复位内固定治疗的40例伤后3周以上有症状的肱骨外侧髁骨折患者进行回顾性研究。骨折按雅各布分类法描述。对患者的X线片进行评估，并采用梅奥肘关节评分和迪隆评分系统以及活动范围进行临床评估。
除1例因先前骨折手术并发缺血性坏死外，其余39例骨折均愈合，平均愈合时间为7.8周。平均梅奥评分为93分，平均迪隆评分为7.6分。活动弧度平均改善40.32°（77.3 - 117.6°）。年龄较小和手术时间较短对结果有统计学意义但较弱的影响。
手术治疗的骨折功能结果显示良好，即使是伤后12周以上出现的骨折。对于就诊较晚的儿童患者家庭，应提供切开复位内固定术以改善功能并减轻症状。
