Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, 37075, Goettingen, Germany.
BMC Musculoskelet Disord. 2021 Dec 6;22(1):1022. doi: 10.1186/s12891-021-04909-y.
After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time.
A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered.
Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°.
After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity.
LEVEL OF EVIDENCE/CLINICAL RELEVANCE: Therapeutic Level IV.
儿童发生移位性肱骨髁上骨折（SCHF）后，常见残留畸形，其中肘内翻（CV）是临床上最明显的。远端骨折块旋转移位可导致不稳定、骨折块倾斜和随后的 CV。旋转移位的检测和评估较为困难，创伤后肱骨干扭转畸形的转归尚不清楚。本研究旨在评估手术治疗的 SCHF 儿童中肱骨扭转差异的发生率，并观察随时间的自发变化。
对 27 例经手术治疗的移位性肱骨髁上骨折患儿进行前瞻性队列研究，从诊断到创伤后 12 个月进行随访。定期获取临床、影像学、超声和放射学数据。对肩肘运动、肘轴线、超声测量肱骨扭转度以及重点评估旋转突起的放射学评估进行差异比较。
创伤后 6 周，67%的 SCHF 患儿超声检测到的肱骨扭转差异>5°（平均 14.0±7.6°）。其中，44%的患儿在放射学上出现旋转突起、轻度外翻或内翻。随访期间，差异从 14°（6 周）平均降低至 7.8°（4 个月）、6.5°（6 个月）和 4.9°（12 个月）。在<5 岁和内旋>20°的患儿中，创伤后肱骨扭转的矫正最为显著。
在移位性和经手术治疗的 SCHF 后，大多数患儿双侧均有肱骨扭转差异。这种差异在创伤后 1 年内由于健侧的变化或严重畸形的儿童的矫正而减小。
证据水平/临床相关性：治疗性 IV 级。
