Simanovski Naum, Horowitz Roy S, Goldman Vladimir, Sharabati Tarek, Lamdan Ron, Zaidman Michael
Orthopedic Department, Hadassah Medical Center, Jerusalem, Israel; and.
Orthopedic Department, Assuta Hospital, Ashdod, Israel.
J Orthop Trauma. 2023 Feb 1;37(2):e68-e72. doi: 10.1097/BOT.0000000000002471.
We report our clinical results following surgical intervention for capitellar fractures in a pediatric population, highlighting approaches, surgical instruments, and possible prognostic factors.
Retrospective descriptive case-series study.
A tertiary referral hospital.
Twelve pediatric patients with capitellar or capitellar-trochlear injuries were treated between 2017 and 2021.
Open reduction and internal fixation primarily using cannulated headless screws.
The mean follow-up period was 22 months (range: 10-35 months). Functional outcomes were assessed using the Mayo Elbow Performance Score. Post-traumatic elbow arthrosis was assessed using the Bromberg and Morrey rating system.
All fractures healed within 5-7 weeks. The mean Mayo Elbow Performance Score value was 98 (range, 85-100). Three patients developed arthrosis, and one had capitellar osteonecrosis.
Based on our experience, the Kocher approach and fixation of 2-3 retrograde cannulated screws together represent an appropriate surgical technique for isolated capitellar fractures, whereas good functional outcomes are attainable for capitellar-trochlear shear fractures using the transolecranon approach with 3 cannulated screw fixations. Further injuries to the osseoligamentous structures around the elbow joint are suspected to be an unfavorable prognostic factor.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
我们报告了对儿童人群的肱骨小头骨折进行手术干预后的临床结果，重点介绍了手术方法、手术器械和可能的预后因素。
回顾性描述性病例系列研究。
一家三级转诊医院。
2017年至2021年间，12例患有肱骨小头或肱骨小头-滑车损伤的儿童患者接受了治疗。
主要采用空心无头螺钉进行切开复位内固定。
平均随访期为22个月（范围：10 - 35个月）。使用梅奥肘关节功能评分评估功能结果。使用布罗姆伯格和莫里评分系统评估创伤后肘关节关节炎。
所有骨折均在5 - 7周内愈合。梅奥肘关节功能评分的平均值为98分（范围，85 - 100分）。3例患者出现关节炎，1例发生肱骨小头缺血性坏死。
根据我们的经验，科赫尔入路和2 - 3枚逆行空心螺钉固定共同构成了孤立性肱骨小头骨折的合适手术技术，而对于肱骨小头-滑车剪切骨折，采用经鹰嘴入路并使用3枚空心螺钉固定可获得良好的功能结果。怀疑肘关节周围骨韧带结构的进一步损伤是一个不利的预后因素。
治疗性四级。有关证据级别的完整描述，请参阅作者指南。
