Trisolino Giovanni, Antonioli Diego, Gallone Giovanni, Stallone Stefano, Zarantonello Paola, Tanzi Piergiuseppe, Olivotto Eleonora, Stilli Luca, Di Gennaro Giovanni Luigi, Stilli Stefano
Unit of Pediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Children (Basel). 2021 Jan 18;8(1):56. doi: 10.3390/children8010056.
Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial.
Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien-Dindo-Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS).
The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), "in-situ" fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2-16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement ≥5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS.
Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures.
肱骨外侧髁（LHC）的陈旧性骨折是指受伤后3周以上才被误诊或治疗不充分的骨折。儿童陈旧性LHC骨折的治疗仍存在争议。
本回顾性研究纳入了27名儿童。对病历和医疗记录进行调查，以了解人口统计学信息、受伤与治疗之间的时间间隔以及治疗类型。评估基线X线片的骨折分级和移位情况。对最终X线片进行调查，以了解骨愈合、缺血性坏死、肘部畸形和生长障碍情况。并发症按照Clavien-Dindo-Sink（CDS）系统进行分类。根据Dhillon评分（DhiS）和Mayo肘关节功能评分（MEPS）评估治疗结果。
从受伤到就诊的平均时间为27个月。治疗方法包括非手术治疗（6例患者）、“原位”固定（7例患者）、切开复位内固定（11例患者）和截骨矫正术（3例患者）。平均随访时间为7年（范围：2 - 16年）。总体而言，我们观察到16例患者（59%）出现并发症；6例并发症被认为是严重并发症（22%），发生在Weiss 3级骨折且外侧移位≥5 mm的患者中。在最近一次随访时，27例患者中有23例（85%）的疼痛和功能评分有所改善。平均MEPS从术前的平均62分提高到术后的98分，而平均DhiS平均从5分提高到8分。CDS评分以及受伤与治疗之间的时间间隔是MEPS和DhiS的独立预测因素。
我们的研究描述了一组接受不同治疗的儿童陈旧性LHC骨折的治疗结果。受伤与治疗之间的时间间隔延长以及围手术期严重并发症对治疗结果产生了负面影响。我们的研究结果强化了对陈旧性LHC骨折手术治疗广泛认可的指南的需求。
