Shen Xiangyang, Jia Guoqiang, Zhang Sicheng
Department of Orthopedics, Anhui Medical University Children's Medical Center/Anhui Provincial Children's Hospital, Hefei Anhui, 230051, P. R. China.
The Fifth Clinical College of Anhui Medical University, Hefei Anhui, 230000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):862-866. doi: 10.7507/1002-1892.202404022.
To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children.
A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared.
All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( >0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications.
EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.
分析外固定架联合克氏针（EF-KW）固定治疗儿童肱骨远端干骺端-骨干交界区（DHMDJ）斜形和粉碎性骨折的疗效。
回顾性分析2021年4月至2023年12月间符合入选标准的22例DHMDJ骨折患儿的临床资料。所有患者均采用EF-KW固定治疗。其中男14例，女8例，平均年龄6.8岁（范围1.5 - 12.0岁）。受伤至手术时间为14 - 38小时（平均24.2小时）。粉碎性骨折18例，斜形骨折4例；术前合并正中神经损伤1例，桡神经损伤1例。记录术后并发症发生情况。末次随访时，根据Mayo肘关节功能评分评估患侧肘关节功能，并记录和比较患侧与健侧的Baumann角（BA）和肱骨头-滑车角（HCA）。
所有骨折均经闭合复位成功治疗，未发生神经损伤等并发症。术后4例发生浅表感染，经对症治疗后愈合。其他患者切口均一期愈合。所有患者随访9 - 24个月（平均13.8个月）。末次随访时，根据Mayo肘关节功能评分，肘关节功能评定为优15例，良6例，可1例，优良率为95.5%。术前神经损伤逐渐恢复。X线片复查显示所有骨折均愈合，骨折愈合时间为29 - 61天，平均35.6天。末次随访时，健侧与患侧的BA和HCA差异无统计学意义（>0.05）。随访期间，1例出现轻度肘内翻，其他患者未发生严重并发症。
EF-KW固定治疗儿童DHMDJ斜形和粉碎性骨折具有创伤小、操作简单、复位容易、复位后稳定性好、严重并发症发生率低及肘关节功能恢复良好等优点。
