Division of Orthopaedics, The Children's Hospital of Philadelphia, PA.
Department of Orthopaedic Surgery, The Chaim Sheba Medical Center, Tel Hashomer.
J Pediatr Orthop. 2021;41(5):273-278. doi: 10.1097/BPO.0000000000001794.
Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures.
In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with <2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions.
Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Tourniquet time was similar between groups (P=0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P<0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation.
While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications.
Therapeutic level III-retrospective cohort study.
内侧髁骨折的手术治疗可以在仰卧位或俯卧位进行。在仰卧位，由于内侧髁的后位，骨折的可视化有时会很困难。然而，俯卧位需要广泛的患者重新定位，但可能会改善可视化。本研究的目的是比较仰卧位和俯卧位治疗内侧髁骨折的结果和并发症。
在回顾性病历分析中，我们确定了 2011 年 1 月至 2019 年 8 月期间接受急性内侧髁骨折切开复位内固定的 18 岁以下患者。排除随访时间<2 个月和伴发骨折的患者。记录并比较了仰卧位和俯卧位之间的手术变量、结果和并发症。
16 位外科医生治疗了本研究中评估的 204 名患者。平均年龄为 11.7 岁。总共 122 例（60%）患者在仰卧位治疗，82 例（40%）在俯卧位治疗。仰卧组的平均手术时间为 113 分钟，俯卧组为 141 分钟（P<0.001）。两组的止血带时间相似（P=0.4）。仰卧位和俯卧位的骨折首次术后 X 线片的移位分别为 2.06mm 和 1.1mm（P<0.001）。我们还发现测量的观察者间和观察者内的可靠性较好。5 例（2.5%）因僵硬需要再次手术，2 例因骨折不愈合，1 例因迟发性尺神经麻痹，53 例（26%）因手术硬件取出。手术体位与并发症或再次手术无关。
虽然俯卧位需要在手术室中增加时间，可能是为了定位，但这两种体位的手术过程本身并没有区别。虽然我们中心的外科医生倾向于俯卧位，尝试过的医生通常会以这种方式进行所有后续的病例，但这两种体位都能提供出色的临床结果，并发症很少。
治疗性 III 级-回顾性队列研究。
