Orthopedic Surgery, University of Oklahoma, Oklahoma City, OK.
J Pediatr Orthop. 2022 Jul 1;42(6):314-320. doi: 10.1097/BPO.0000000000002154. Epub 2022 Apr 13.
The optimal treatment of Gartland type IIa supracondylar humerus fractures remains controversial. We report the results of a series of patients with type IIa fractures who underwent closed reduction and immobilization using conscious sedation in the emergency department. Our goal was to identify variables associated with fractures that were successfully managed nonoperatively.
This was a retrospective cohort study of pediatric patients who underwent closed reduction of Gartland type IIa supracondylar humerus fractures with the use of conscious sedation in the emergency department. Prereduction and postreduction radiographs were reviewed to determine the degree of fracture extension, anterior humeral line index, Baumann angle, and splint flexion angle. The success of closed reduction was defined as a reduction that was maintained without the need for surgical intervention.
A total of 54 patients (54 elbows) were included in this study. The mean overall age was 5.2±2.5 years. Following the closed reduction in the emergency department, 38 (70%) patients were successfully managed nonoperatively with casting, and 16 (30%) patients required operative intervention. The degree of fracture extension on the injury radiograph was 13.2±8.4 degrees in the nonoperative group compared with 19.8±7.5 degrees in the operative group (P=0.008). The postreduction degree of fracture extension was 3.0±3.4 degrees in the nonoperative group and 10.0±7.2 degrees in the operative group (P<0.0001). The mean anterior humeral line index on the injury radiograph was 0.34 in the nonoperative group and 0.13 in the operative group (P=0.104). The mean anterior humeral line index on the postreduction radiograph was 1.2 in the nonoperative group and 0.38 in the operative group (P=0.0002). Patient age, prereduction and postreduction Baumann angle, and the postreduction splint flexion angle did not differ significantly between groups.
Closed reduction under conscious sedation in the emergency department is a viable treatment option for Gartland type IIa supracondylar humerus fractures. Increasing fracture extension on injury radiographs can help predict failure of nonoperative management following closed reduction.
Level III-retrospective comparative study.
Gartland Ⅱa 型肱骨髁上骨折的最佳治疗方法仍存在争议。我们报告了一组在急诊科行闭合复位和固定的Ⅱa 型骨折患者的结果，使用的是清醒镇静。我们的目标是确定与非手术治疗成功相关的变量。
这是一项回顾性队列研究，纳入在急诊科接受清醒镇静下闭合复位的 Gartland Ⅱa 型肱骨髁上骨折患儿。回顾术前和术后 X 线片，以确定骨折延伸程度、肱骨干前缘指数、Baumann 角和夹板弯曲角度。闭合复位成功的定义为无需手术干预即可维持的复位。
本研究共纳入 54 例（54 肘）患者。平均年龄为 5.2±2.5 岁。在急诊科行闭合复位后，38 例（70%）患者经非手术治疗（石膏固定）成功，16 例（30%）患者需手术干预。非手术组的骨折 X 线片上骨折延伸程度为 13.2±8.4 度，手术组为 19.8±7.5 度（P=0.008）。非手术组术后骨折延伸程度为 3.0±3.4 度，手术组为 10.0±7.2 度（P<0.0001）。非手术组骨折 X 线片上肱骨干前缘指数为 0.34，手术组为 0.13（P=0.104）。非手术组术后 X 线片上肱骨干前缘指数为 1.2，手术组为 0.38（P=0.0002）。两组患者的年龄、术前和术后 Baumann 角以及术后夹板弯曲角度无显著差异。
急诊科在清醒镇静下进行闭合复位是 Gartland Ⅱa 型肱骨髁上骨折的一种可行治疗方法。受伤 X 线片上骨折延伸程度的增加有助于预测闭合复位后非手术治疗的失败。
III 级-回顾性比较研究。
