Weng Liuqi, Zhang Ge, Zhou Hai, Liu Xing, Cao Yujiang, Zhang Yuan
Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China.
Department of Orthopaedics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China.
Injury. 2024 Mar;55(3):111309. doi: 10.1016/j.injury.2023.111309. Epub 2024 Jan 5.
Lateral humeral condyle fractures (LHCFs) are the most common intra-articular fracture occurring at the elbow in children. Conventional treatment for displaced pediatric LHCFs is open reduction and percutaneous pinning, and few studies have regarded the efficacy of arthroscopic-assisted techniques. We aimed to evaluate the efficacy of anatomic reduction via elbow arthroscopy for pediatric humeral lateral condyle fractures with displacements >4 mm.
A total of 32 children with LHCFs featuring displacements >4 mm were enrolled in this retrospective study. Arthroscopically assisted reduction was performed as the primary treatment approach. For simple displaced fractures, arthroscopically assisted reduction was directly employed with intermittent intra-articular irrigation. For fractures with distal fragment rotation, the rotated fragments were firstly realigned into a simple displaced position under fluoroscopy before proceeding with arthroscopy. The success rate of arthroscopically assisted reduction and clinical outcomes at the latest follow-up were assessed, and complications related to the procedure were monitored.
Twenty-nine of 32 (90.62 %) enrolled cases were successfully treated with arthroscopically assisted reduction. Failure cases were attributed to soft tissue swelling, which hindered the manipulation of the fracture fragments for reduction or fixation. We subsequently adapted the surgical procedure, resulting in a significant increase in the success of arthroscopically assisted reduction, rising from 71.43 % to 96 %. Among the 29 successfully treated cases, excellent functional outcomes were observed in 18 cases, and 11 cases showed good outcomes. Regarding the carrying angle outcomes, 28 patients achieved excellent results, with one patient having a good outcome. The most frequent radiographic finding after surgery was lateral spur formation without further negative effects. Only one case of superficial infection occurred, promptly healing with topical management. No significant complications such as neurovascular injury or compartment syndrome were observed.
Arthroscopically assisted anatomic reduction provides a promising alternative to open reduction for LHCFs with displacements exceeding 4 mm, offering direct visualization of the articular surface and minimizing soft tissue dissection.
肱骨外侧髁骨折（LHCFs）是儿童肘部最常见的关节内骨折。儿童移位性LHCFs的传统治疗方法是切开复位经皮穿针固定，很少有研究关注关节镜辅助技术的疗效。我们旨在评估通过肘关节镜解剖复位治疗移位>4mm的儿童肱骨外侧髁骨折的疗效。
本回顾性研究共纳入32例移位>4mm的LHCFs患儿。以关节镜辅助复位作为主要治疗方法。对于单纯移位骨折，直接采用关节镜辅助复位并间歇性关节内冲洗。对于伴有远端骨折块旋转的骨折，在进行关节镜检查前，先在透视下将旋转的骨折块复位至单纯移位位置。评估关节镜辅助复位的成功率及最新随访时的临床结果，并监测与手术相关的并发症。
32例纳入病例中有29例（90.62%）通过关节镜辅助复位成功治疗。失败病例归因于软组织肿胀，这妨碍了骨折块的复位或固定操作。我们随后调整了手术方法，使关节镜辅助复位的成功率显著提高，从71.43%升至96%。在29例成功治疗的病例中，18例功能结果优秀，11例结果良好。关于提携角结果，28例患者结果优秀，1例患者结果良好。术后最常见的影像学表现是外侧骨赘形成，无进一步不良影响。仅发生1例浅表感染，经局部处理后迅速愈合。未观察到神经血管损伤或骨筋膜室综合征等严重并发症。
对于移位超过4mm的LHCFs，关节镜辅助解剖复位为切开复位提供了一种有前景的替代方法，可直接观察关节面并最大限度减少软组织分离。
