Royal London Hospital Orthopaedic Department.
Barts and The London School of Medicine and Dentistry, London, UK.
J Pediatr Orthop. 2024 Apr 1;44(4):203-207. doi: 10.1097/BPO.0000000000002636. Epub 2024 Feb 8.
There are now recognized standards of care published by the British and American Orthopaedic Associations which detail key areas of evidence-based recommendations for the treatment of children with displaced supracondylar humerus fractures. Although many aspects of treatment are covered in these recommendations, both the American and British Orthopaedic Associations do not recommend the exact duration of immobilization postoperatively.
This study retrospectively compared outcomes of operatively managed supracondylar fractures immobilized postoperatively for short immobilization (SI) defined as 28 days or less, with long immobilization (LI) defined as more than 28 days. The outcomes measured were clinical (deformity, range of motion, and pin site infection) and radiologic (loss of position after the removal of K-wires, Baumann's angle, anterior humeral line, refracture, and signs of osteomyelitis). Demographic data were recorded to evaluate and ensure satisfactory matching of the 2 groups for analysis.
The study included 193 pediatric supracondylar fractures over a 4-year period which were treated with manipulation under anesthetic and K-wire fixation. The difference in average time in plaster between the 2 groups was statistically significant (SI: n=27.5 d, SD 1.23; LI: n=43.9 d, SD 15.29, P =0.0001). Data for operative techniques-closed or open reduction (SI: n=66, LI: n=78, P =0.59), and crossed wires (SI: n=37, LI: n=50, P =0.57) between the two groups showed no statistical significance. There was no statistical difference between the groups for the average number of days postoperatively at which wires were taken out (SI: n=28.9 d, SD 5.95, LI: n=30.1 d, SD 5.57, P =0.15), number of pin site infections requiring antibiotic treatment (SI: n=3, LI: n=5, P =0.70), or children from each group who were recorded to have regained full range of motion symmetrical to their contralateral arm (SI: n=79, LI: n=99, P =0.74).
Our study therefore suggests that shorter immobilization of these patients (SI group) does not yield a higher rate of complications including refracture and malunion.
英国和美国骨科协会发布了公认的护理标准，详细说明了治疗儿童移位性肱骨髁上骨折的循证推荐的关键领域。尽管这些建议涵盖了治疗的许多方面，但美国和英国骨科协会都不建议术后固定的确切时间。
本研究回顾性比较了术后接受短固定（SI）治疗的儿童髁上骨折（定义为 28 天或更短）和长固定（LI）治疗的结果（定义为超过 28 天）。测量的结果是临床（畸形、运动范围和针道感染）和影像学（去除 K 线后的位置丢失、Baumann 角、肱骨前侧线、再骨折和骨髓炎迹象）。记录人口统计学数据，以评估和确保两组分析的满意匹配。
这项研究包括在 4 年期间接受麻醉下手法复位和 K 线固定治疗的 193 例儿童髁上骨折。两组患者平均石膏固定时间差异具有统计学意义（SI 组：n=27.5 d，标准差 1.23；LI 组：n=43.9 d，标准差 15.29，P=0.0001）。两组间手术技术（闭合或开放复位，SI 组：n=66，LI 组：n=78，P=0.59）和交叉线（SI 组：n=37，LI 组：n=50，P=0.57）的数据无统计学意义。两组患者术后取出克氏针的平均天数（SI 组：n=28.9 d，标准差 5.95；LI 组：n=30.1 d，标准差 5.57，P=0.15）、需要抗生素治疗的针道感染发生率（SI 组：n=3，LI 组：n=5，P=0.70）或记录到双侧手臂运动范围完全对称恢复的患者比例（SI 组：n=79，LI 组：n=99，P=0.74）无统计学差异。
因此，我们的研究表明，这些患者（SI 组）的较短固定时间并不会导致更高的并发症发生率，包括再骨折和畸形愈合。
