Pan Tommy, Widner Matthew R, Chau Michael M, Hennrikus William L
Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, USA.
Department of Orthopaedic Surgery, University of Minnesota Twin Cities, Minneapolis, USA.
Cureus. 2021 Mar 15;13(3):e13903. doi: 10.7759/cureus.13903.
Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children.
Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks.
After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred.
Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases.
肱骨髁上骨折（SCH）是儿童最常见的肘部骨折；然而，开放性损伤很少见。开放性骨折与感染、神经血管损伤、骨筋膜室综合征及骨不连的发生率较高相关。本研究的目的是评估儿童开放性SCH骨折的治疗方法及疗效。
2008年至2015年期间，在单一中心接受治疗的420例SCH骨折患儿中，有4例（1%）为开放性损伤。患者平均年龄为6岁（范围4至8岁）。2例患者为Gustilo-Anderson Ⅰ级开放性骨折，2例为Ⅱ级骨折。所有患者破伤风免疫接种均在有效期内。平均在受伤后3小时7分钟（范围1小时38分钟至8小时15分钟）给予首剂静脉抗生素。从受伤到清创冲洗（I&D）及闭合复位经皮穿针固定（CRPP）的时间平均为8小时16分钟（范围4小时19分钟至13小时15分钟）。所有患者均接受24小时静脉抗生素治疗。4周时拔除钢针，6周时实现骨愈合。
平均随访12个月（范围6至22个月）后，未发生感染、神经血管功能缺损、骨筋膜室综合征、肘内翻畸形或活动度丧失。根据Flynn标准，所有结果均为优。由于开放性SCH骨折的不稳定性，4例均使用了内侧钢针。未发生复位丢失或尺神经损伤。
开放性损伤约占儿童所有SCH骨折的1%。作者推荐对开放性SCH骨折采用紧急静脉抗生素治疗、清创冲洗及使用内侧钢针的CRPP治疗。4例患者根据Flynn标准均获得了良好的疗效。
