Zhou Zhilin, Ma Hailong, Sun Jun, Yuan Yi, Zhang Sicheng, Liu Fang, Hua Zhongtuo, Guan Zhiye
Department of Orthopedics, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei Anhui, 230051, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Feb 15;37(2):142-146. doi: 10.7507/1002-1892.202210085.
To explore the effectiveness of thumb blocking technique through closed reduction of ulnar Kirschner wire threading in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children.
The clinical data of 58 children with Gartland type Ⅲ supracondylar humerus fractures treated with closed reduction of ulnar Kirschner wire threading by thumb blocking technique between January 2020 and May 2021 were retrospectively analyzed. There were 31 males and 27 females with an average age of 6.4 years ranging from 2 to 14 years. The causes of injury were falling in 47 cases and sports injury in 11 cases. The time from injury to operation ranged from 24.4 to 70.6 hours, with an average of 49.6 hours. The twitch of ring and little fingers was observed during operation, the injury of ulnar nerve was observed after operation, and the healing time of fracture was recorded. At last follow-up, the effectiveness was evaluated by Flynn elbow score, and the complications were observed.
There was no twitch of the ring and little fingers when the Kirschner wire was inserted on the ulnar side during operation, and the ulnar nerve was not injured. All children were followed up 6-24 months, with an average of 12.9 months. One child had postoperative infection in the operation area, local skin redness and swelling, and purulent secretion exudation at the eye of the Kirschner wire, which was improved after intravenous infusion and regular dressing change in the outpatient department, and the Kirschner wire was removed after the initial healing of the fracture; 2 children had irritation at the end of the Kirchner wire, and recovered after oral antibiotics and dressing change in the outpatient department. There was no serious complication such as nonunion and malunion, and the fracture healing time ranged from 4 to 6 weeks, with an average of 4.2 weeks. At last follow-up, the effectiveness was evaluated by Flynn elbow score, which was excellent in 52 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 96.6%.
The treatment of Gartland type Ⅲ supracondylar humerus fractures in children by closed reduction and ulnar Kirschner wire fixation assisted with thumb blocking technique is safe and stable, and will not cause iatrogenic ulnar nerve injury.
探讨拇指阻挡技术辅助尺骨克氏针穿针闭合复位治疗儿童肱骨髁上GartlandⅢ型骨折的疗效。
回顾性分析2020年1月至2021年5月采用拇指阻挡技术辅助尺骨克氏针穿针闭合复位治疗的58例儿童肱骨髁上GartlandⅢ型骨折的临床资料。其中男31例，女27例，平均年龄6.4岁，年龄范围2～14岁。受伤原因：跌倒47例，运动损伤11例。受伤至手术时间为24.4～70.6小时，平均49.6小时。术中观察环指及小指抽动情况，术后观察尺神经损伤情况，并记录骨折愈合时间。末次随访时采用Flynn肘关节评分评估疗效，并观察并发症情况。
术中尺侧穿针时无环指及小指抽动，尺神经未损伤。所有患儿均获随访6～24个月，平均12.9个月。1例患儿术后手术区域感染，局部皮肤红肿，克氏针针眼处有脓性分泌物渗出，经静脉输液及门诊定期换药后好转，骨折初步愈合后拔除克氏针；2例患儿克氏针尾端有刺激症状，经门诊口服抗生素及换药后恢复。无骨不连、畸形愈合等严重并发症，骨折愈合时间4～6周，平均4.2周。末次随访时采用Flynn肘关节评分评估疗效：优52例，良4例，可２例，优良率为96.6%。
拇指阻挡技术辅助尺骨克氏针内固定闭合复位治疗儿童肱骨髁上GartlandⅢ型骨折安全可靠，不会造成医源性尺神经损伤。
