Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035, China.
Int Orthop. 2021 Aug;45(8):2025-2031. doi: 10.1007/s00264-021-05010-8. Epub 2021 Apr 12.
Trans-olecranon fracture-dislocations are rare in children. To our knowledge, only 12 cases have been described in children till now and the treatment strategy for this injury in children remains unclear. To provide a clear clinical description and more accurate treatment options, we retrospectively reviewed cases with this kind of injury in our institution.
From 2002 to 2019, eleven cases diagnosed with trans-olecranon fracture-dislocation of the elbow were identified, and their medical charts and radiographs were obtained. All patients underwent open reduction and internal fixation through a posterior approach. At the most recent follow-up visit, all patients were evaluated clinically using the Mayo Elbow Performance Score (MEPS).
The mean follow-up was 22 months (range, 6-42 months). All injuries were unilateral, and there were nine males and two females. The mean age at injury was nine years (range, 4-13 years), and the mean time from injury to surgery was 16.6 days (range, 2-60 days). According to Tiemdjo classification, there was one case with type I injury, one case with type II, six cases with type III, and three cases with type IV. According to the MEPS criteria, the outcomes were excellent in five cases, good in two cases, fair in one case, and poor in three cases. Four patients were delayed cases, who underwent surgery two weeks after injury. The average operation time was significantly longer in four children sustaining delayed surgery (140 ± 43 min, vs. 50 ± 12 min, p < 0.001).
To our knowledge, this is the largest sample size reported to date. We recommend open reduction and internal fixation, using either plates or tension-band techniques, depending on the injury pattern. In addition, we emphasize that early operation could achieve good clinical outcomes.
儿童发生经鹰嘴骨折-脱位较为罕见。据我们所知，目前仅有 12 例此类儿童病例的相关报道，对于该损伤的治疗策略仍不明确。为了提供更清晰的临床描述和更准确的治疗选择，我们回顾性分析了本机构此类损伤的病例。
自 2002 年至 2019 年，我们共确诊了 11 例儿童经鹰嘴骨折-脱位患者，获取了他们的病历和影像学资料。所有患者均通过后入路行切开复位内固定治疗。末次随访时，所有患者均采用 Mayo 肘关节功能评分（MEPS）进行临床评估。
平均随访时间为 22 个月（6-42 个月）。所有损伤均为单侧，男性 9 例，女性 2 例。损伤时的平均年龄为 9 岁（4-13 岁），受伤至手术的平均时间为 16.6 天（2-60 天）。根据 Tiemdjo 分型，Ⅰ型 1 例，Ⅱ型 1 例，Ⅲ型 6 例，Ⅳ型 3 例。根据 MEPS 标准，5 例疗效为优，2 例为良，1 例为可，3 例为差。4 例为延迟手术病例，受伤后 2 周行手术治疗。4 例延迟手术患儿的平均手术时间明显更长（140±43 min，vs. 50±12 min，p<0.001）。
据我们所知，这是迄今为止最大的样本量报道。我们建议采用切开复位内固定，根据损伤类型选择使用钢板或张力带技术。此外，我们强调早期手术可以获得良好的临床效果。
