Paediatric Orthopaedic Department, Hospital Universitari Son Espases, Ctra. Valldemossa, 79, 07120, Palma, Spain.
Orthopaedic Department, Hospital Universitario La Fe, Valencia, Spain.
Int Orthop. 2024 Jun;48(6):1453-1461. doi: 10.1007/s00264-024-06153-0. Epub 2024 Apr 6.
To evaluate the functional and cosmetic effects of elbow supracondylar fractures (SCF) in children with residual rotational deformity.
Retrospective review cohort of patients with evidence of malrotation after treatment for SCF. An analysis of the postoperative X-ray of 305 consecutive SCF type 3 treated surgically during five years identified 46 elbows with rotational deformity that fulfilled the selection criteria and were recalled for review; only 27 patients agreed to participate. Patients were evaluated clinically and radiographically. Clinically, the elbow and shoulder ROM were assessed. The postoperative fracture rotation (PFR) was radiologically measured using the Berdis method. Results were categorized according to Flynn criteria, and functional outcomes were evaluated with the QuickDASH questionnaire. On final assessment, a radiograph of both elbows was obtained, and measures were compared. Descriptive analysis was made calculating median, range, proportions, and confidence intervals. Non-parametric tests were used to test the association between variables.
The group had a median age of four years and a median follow-up of 52 months. Shoulder rotation was asymmetrical in 13 patients; six patients presented a change on carrying angle > 5° (4 varus/2 valgus). The higher the residual rotation, the higher the chances of an altered shoulder rotation (for each degree of PFR, the shoulder rotation was changed to 0.4°). However, there was a low correlation between the amount of rotation and the final carrying angle (r = 0.37). According to Flynn's criteria, over 95% had excellent or good results.
There was a weak correlation between varus and rotational malalignment. Patients with moderate residual malrotation could be expected to have a good outcome even if some shoulder rotation changes persist.
评估儿童肱骨髁上骨折（SCF）遗留旋转畸形的功能和美容效果。
回顾性分析接受 SCF 治疗后存在旋转移位的患者。对 5 年内接受手术治疗的 305 例连续 3 型 SCF 患者的术后 X 线片进行分析，发现符合选择标准并召回进行评估的 46 例旋转畸形肘关节；只有 27 名患者同意参与。患者接受临床和影像学评估。临床方面，评估肘部和肩部的 ROM。使用 Berdis 法测量术后骨折旋转（PFR）。结果根据 Flynn 标准进行分类，并使用 QuickDASH 问卷评估功能结果。最终评估时，获取双侧肘部的 X 线片并进行比较。采用中位数、范围、比例和置信区间进行描述性分析。使用非参数检验来检验变量之间的相关性。
该组患者的中位年龄为 4 岁，中位随访时间为 52 个月。13 例患者存在肩部旋转不对称；6 例患者的携带角改变>5°（4 例内翻/2 例外翻）。残留旋转角度越高，肩部旋转改变的可能性越大（每度 PFR，肩部旋转改变 0.4°）。然而，旋转量与最终携带角之间的相关性较低（r=0.37）。根据 Flynn 标准，超过 95%的患者获得了优秀或良好的结果。
存在轻度的内翻与旋转畸形之间的相关性。对于中度残留畸形的患者，即使存在一些肩部旋转改变，仍可预期获得良好的结果。
