Department of Orthopedics and Rehabilitation, PennState Health Milton S. Hershey Medical Center.
Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA.
J Pediatr Orthop. 2021 Apr 1;41(4):e342-e346. doi: 10.1097/BPO.0000000000001772.
While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures.
The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and the study group, those with open injuries. Study variables were age, sex, weight, injury severity score, length of stay (LOS), nerve injury, ipsilateral forearm fracture, compartment syndrome/fasciotomy, requirement for a vascular procedure. Other variables were mode of treatment, provisional reduction, repeat reduction, time interval between referring facility admission and operation, and time from emergency department admission to operation.
A total of 4308 subjects were included, 104 (2.4%) of whom had an open SC fracture. LOS was 2 days for the study group versus 1 day for controls (P<0.001). Open SC fractures were more likely than closed to be associated with a nerve injury (13.5% vs. 3.7%), ipsilateral forearm fracture (18.3% vs. 6.4%) and/or a vascular procedure (6.7% vs. 0.3%) (P<0.001). 5.9% of those in the study group required repeat surgery compared with 0.4% for controls (P<0.001). Time from emergency department admission to operation was 3.2 versus 10.3 hours (P<0.001).
We report the largest series to date of open SC fractures in children. Surgeons caring for such patients should be aware of their increased risks for both associated injuries and potential requirement for vascular reconstruction. The majority of children with an open SC fracture are managed with 1 operation and in the absence of vascular injury, seldom require an extended LOS.
Level III-retrospective cohort study.
虽然髁上（SC）骨折在儿童中较为常见，但开放性损伤的发生率据信仅为 1%。两项关于儿童开放性 SC 骨折的既往研究报告称，血管损伤的发生率增加。本研究的目的是阐明开放性 SC 骨折的发生率、相关情况和当前治疗方法。
我们查询了宾夕法尼亚创伤结局研究数据库。纳入 2000 年 1 月至 2015 年 12 月期间在创伤中心就诊的年龄在 25 至 156 个月的 SC 骨折患者。对照组为闭合性骨折患者，研究组为开放性损伤患者。研究变量包括年龄、性别、体重、损伤严重程度评分、住院时间（LOS）、神经损伤、同侧前臂骨折、筋膜切开减压术、血管手术的需要。其他变量包括治疗方式、临时复位、重复复位、从转诊机构入院到手术的时间间隔，以及从急诊入院到手术的时间。
共纳入 4308 例患者，其中 104 例（2.4%）为开放性 SC 骨折。研究组的 LOS 为 2 天，而对照组为 1 天（P<0.001）。与闭合性骨折相比，开放性 SC 骨折更有可能伴有神经损伤（13.5% vs. 3.7%）、同侧前臂骨折（18.3% vs. 6.4%）和/或血管手术（6.7% vs. 0.3%）（P<0.001）。研究组中有 5.9%的患者需要再次手术，而对照组为 0.4%（P<0.001）。从急诊入院到手术的时间为 3.2 小时，而对照组为 10.3 小时（P<0.001）。
我们报告了迄今为止最大的儿童开放性 SC 骨折系列研究。治疗此类患者的外科医生应意识到，他们发生相关损伤和潜在血管重建需求的风险增加。大多数开放性 SC 骨折的儿童仅需一次手术治疗，且在无血管损伤的情况下，很少需要延长 LOS。
III 级-回顾性队列研究。
