Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Korea.
BMC Musculoskelet Disord. 2023 Aug 12;24(1):649. doi: 10.1186/s12891-023-06780-5.
Lateral condyle fracture of the humerus is the second most common elbow fracture in children. Non-displaced lateral condyle fractures can often be managed with cast and conservative care, while reduction and fixation are often used to treat displaced lateral condyle fractures. Traditionally, K-wire fixation has been used for displaced lateral condyle fractures, but recently fixation using screws has been advocated in some studies. Therefore, we performed a meta-analysis to determine the difference in outcomes and complications between the two different fixation methods for the treatment of displaced lateral condyle fractures of the humerus in pediatric patients.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. PubMed, Embase, and Cochrane Library were used for study selection. Studies comparing K-wires and screw fixation in displaced lateral condyle fractures in pediatric patients were included. Clinical outcomes using the Hardacre criteria, infection, limitation of range of motion of the elbow, lateral condyle overgrowth, delayed union, nonunion, and avascular necrosis were compared. Data were analyzed using the meta package in R version 4.2.2, and random-effects or fixed-effects models were used according to heterogeneity.
One randomized controlled study and three retrospective cohort studies were included, with a total of 240 patients (K-wire:118, screw:122). The clinical outcome using the Hardacre criteria was not different between the groups (P = 0.54), but the risk of infection (risk ratio [RR] = 5.52, 95% CI: 1.42-21.48, P = 0.01) and limitation of range of motion (RR = 3.75, 95% CI: 1.54-9.18, P < 0.01) were significantly higher in the K-wire fixation group than in screw fixation group.
The use of screws for fixation after reduction in the treatment of lateral condyle fracture of the humerus in children decreases the risk of superficial infection and elbow stiffness compared with the use of K-wire. Although removal of the implant under general anesthesia is necessary, screw fixation can be considered in displaced lateral condyle fractures of the humerus in children.
PROSPERO (CRD42023415643).
肱骨外髁骨折是儿童中第二常见的肘部骨折。无移位的肱骨外髁骨折通常可以用石膏和保守治疗来治疗，而复位和固定通常用于治疗移位的肱骨外髁骨折。传统上，使用 K 型钉固定治疗移位的肱骨外髁骨折，但最近一些研究主张使用螺钉固定。因此，我们进行了一项荟萃分析，以确定两种不同的固定方法治疗儿童移位肱骨外髁骨折的结果和并发症的差异。
本研究采用系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。使用 PubMed、Embase 和 Cochrane Library 进行研究选择。纳入比较儿童移位肱骨外髁骨折中 K 型钉和螺钉固定的研究。使用 Hardacre 标准比较临床结果，包括感染、肘部活动范围受限、外侧髁过度生长、延迟愈合、不愈合和缺血性坏死。使用 R 版本 4.2.2 中的 meta 包进行数据分析，并根据异质性使用随机效应或固定效应模型。
纳入了一项随机对照研究和三项回顾性队列研究，共有 240 名患者（K 型钉：118 例，螺钉：122 例）。两组间 Hardacre 标准的临床结果无差异（P=0.54），但 K 型钉固定组的感染风险（风险比 [RR]=5.52，95%CI：1.42-21.48，P=0.01）和活动范围受限的风险（RR=3.75，95%CI：1.54-9.18，P<0.01）明显高于螺钉固定组。
与使用 K 型钉相比，儿童肱骨外髁骨折复位后使用螺钉固定可降低浅表感染和肘部僵硬的风险。虽然需要在全身麻醉下取出植入物，但在儿童肱骨外髁骨折中可以考虑使用螺钉固定。
PROSPERO（CRD42023415643）。
