Mehrolhassani Yasamin, Karbalaee Aghazadeh Leila, Oveisee Maziar
School of Medicine, Bam University of Medical Sciences, Bam, Iran.
Orthopedic Department, School of Medicine, Bam University of Medical Sciences, Bam, Iran; Clinical Research Center, Pastor Educational Hospital, Bam University of Medical Sciences, Bam, Iran.
Int J Surg Case Rep. 2023 May;106:108294. doi: 10.1016/j.ijscr.2023.108294. Epub 2023 May 4.
Plastic deformities usually occur in skeletally immature bones not completely ossified due to longitudinal forces on their distal ends, especially the forearm and lower legs. Pediatric lateral humeral condylar fractures (LHCFs) constitute the second most common intra-articular fracture in the upper extremity. Nevertheless, plastic deformities accompanied by other traumatic injuries, including LHCFs, are atypical and rare. This study presents an exceedingly rare case of the concurrence of a plastic deformity and an ipsilateral fracture of the lateral condyle of the humerus in a 6-year-old Persian boy.
The 6-year-old Persian injured boy referred to orthopedic clinic with an obvious deformity in the right upper limb with a limited motion range in the ipsilateral elbow. The patient underwent open-fixation surgery for LHCF fixation and suitable maneuvers to rectify the ulnar plastic deformity. Our findings indicated an acceptable outcome for this approach. His injured limb was reformed without deformities, and the complete union of the fractured area was accomplished eight weeks after surgery.
The case is remarkable as reminding that we have to care concomitant "minor" injuries to the main fracture and to correctly treat them. Furthermore, open fixation surgery for LHCF rectification before fixing the ulnar deformity with the aid of a suitable maneuver led to good outcome and acceptable rehabilitation in a case of concurrent ulnar plastic deformity and an ipsilateral fracture of the external condyle of the humerus.
Our approach helps to avoid further tissue damage and prevent the 2-stage surgical process.
塑性畸形通常发生在骨骼未完全成熟、远端因纵向力而未完全骨化的骨骼中，尤其是前臂和小腿。小儿肱骨外侧髁骨折（LHCFs）是上肢第二常见的关节内骨折。然而，伴有其他创伤性损伤（包括LHCFs）的塑性畸形并不常见且较为罕见。本研究报告了一例极为罕见的病例，一名6岁的波斯男孩同时出现肱骨外侧髁塑性畸形和同侧骨折。
这名6岁的波斯受伤男孩因右上肢明显畸形、同侧肘部活动范围受限转诊至骨科诊所。患者接受了LHCF内固定的切开复位手术，并采取了适当的手法矫正尺骨塑性畸形。我们的研究结果表明这种方法取得了可接受的效果。他受伤的肢体恢复正常且无畸形，术后8周骨折部位完全愈合。
该病例值得注意的是，它提醒我们必须关注主骨折伴随的“轻微”损伤并正确处理。此外，对于同时存在尺骨塑性畸形和肱骨外侧髁同侧骨折的病例，在借助适当手法矫正尺骨畸形之前先进行LHCF切开复位内固定手术，取得了良好的效果和可接受的康复情况。
我们的方法有助于避免进一步的组织损伤并防止二期手术过程。
