Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
J Pediatr Orthop B. 2020 Sep;29(5):452-457. doi: 10.1097/BPB.0000000000000787.
Multidirectionally unstable supracondylar humeral fractures cause severe instability in both flexion and extension movements. The traditional closed reduction often fails to overcome this lack of stability. The aim of this study is to use a closed reduction technique with a transolecranon pin to achieve temporary stability. From 35 pediatric multidirectionally unstable supracondylar humeral fractures hospitalized between March 2012 and March 2018 at our hospital, 23 fractures (65.7%) were treated with closed reduction and percutaneous pinning (CRPP) (group 1) and the remaining twelve fractures (34.3%) were treated utilizing a transolecranon pin joystick technique of CRPP (group 2). Both groups were followed over 16 weeks. The outcomes of our analysis included surgical time, times of fluoroscopy, Baumann angle, postoperative range of motion and complications. The surgical time and times of fluoroscopy were significantly shorter for patients in group 2 when compared with group 1 (P < 0.05). All cases showed restoration of the normal anterior humeral line-capitellar relationship. However, the quality of reduction on the anteroposterior radiographic view was significantly better for patients in group 2 than that of group 1 (P < 0.05). No immediate postoperative complications were observed. The range of motion was similar in both groups during the last follow-up appointment. A transolecranon pin is a safe and effective method for closed reduction of multidirectionally unstable supracondylar humeral fractures in children. The joystick technique can shorten surgical time and improve quality of reduction with no increasing risk of complications. Level of evidence: level III.
多方向不稳定肱骨髁上骨折在屈伸运动中均会导致严重不稳定。传统的闭合复位往往无法克服这种不稳定性。本研究旨在使用经鹰嘴骨突穿针的闭合复位技术来实现暂时的稳定性。从 2012 年 3 月至 2018 年 3 月在我院住院的 35 例多方向不稳定肱骨髁上骨折患儿中，23 例（65.7%）采用闭合复位经皮穿针（CRPP）治疗（1 组），其余 12 例（34.3%）采用经鹰嘴突骨突穿针摇杆技术的 CRPP 治疗（2 组）。两组均随访 16 周。我们的分析结果包括手术时间、透视次数、Baumann 角、术后活动范围和并发症。与 1 组相比，2 组的手术时间和透视次数明显更短（P < 0.05）。所有病例均显示正常肱骨干骺端线-头状骨关系的恢复。然而，2 组的前后位 X 线片的复位质量明显优于 1 组（P < 0.05）。术后均未观察到即刻并发症。末次随访时两组的活动范围相似。经鹰嘴突骨突穿针是一种安全有效的闭合复位治疗儿童多方向不稳定肱骨髁上骨折的方法。摇杆技术可以缩短手术时间，提高复位质量，而不会增加并发症的风险。证据水平：III 级。
