Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO.
Department of Orthopedic Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
J Pediatr Orthop. 2024;44(10):e865-e870. doi: 10.1097/BPO.0000000000002777. Epub 2024 Jul 18.
Lateral humeral condyle (LC) fractures are the second most common pediatric elbow fractures. Traditionally, displaced fractures have been treated with open reduction although recent studies have demonstrated successful outcomes of closed reduction for similar injuries. This study investigates the outcomes comparing open and closed reduction in a large cohort of children with moderately displaced (Song classification types 1 to 4) lateral humeral condyle fractures.
Retrospective data from patients aged between 1 and 12 years treated for lateral condyle fractures was collected from 6 academic level 1 trauma centers between 2005 and 2019. Data was collected on patient demographics, radiographic parameters, reduction type, type of hardware fixation, and fracture patterns. Complications recorded include infections, reoperations for nonunion, osteonecrosis, and elbow stiffness.
An initial 762 fractures were identified. After excluding Song 5 cases, a total of 480 fractures met inclusion criteria, with 202 (42%) treated with closed reduction and 278 (58%) treated with open reduction. Demographics and injury characteristics were similar across the 2 reduction cohorts. After propensity score matching, delayed healing (52% vs. 28%; OR: 2.88, 95% CI: 1.97-4.22; P <0.0001) and stiffness (22% vs. 10%; OR 2.42, 95% CI: 1.42-4.13; P =0.0012) were significantly higher in the open reduction group. No differences in the rates of infection or nonunion (3% CR and 1% OR) were noted between the 2 groups.
This study demonstrates that moderately displaced lateral condyle fractures requiring open reduction are more likely to have elbow stiffness and delayed healing when compared with the ones treated with closed reduction. For these reasons, we propose attempting closed reduction techniques as the first line of treatment in moderately displaced lateral humeral condyle fractures (if anatomic articular reduction can be achieved) to attain better patient outcomes.
肱骨外髁骨折是儿童肘部第二常见的骨折。传统上，对于移位的骨折采用切开复位治疗，尽管最近的研究表明对于类似的损伤，闭合复位也能取得良好的效果。本研究调查了在一个大的儿童肱骨外髁骨折亚组中，比较切开复位和闭合复位的结果。
从 2005 年至 2019 年，在 6 个学术水平为 1 级的创伤中心收集了年龄在 1 至 12 岁之间接受外侧髁骨折治疗的患者的回顾性数据。收集的数据包括患者人口统计学、影像学参数、复位类型、硬件固定类型和骨折模式。记录的并发症包括感染、非愈合的再手术、骨坏死和肘部僵硬。
最初确定了 762 例骨折。排除 Song 5 型病例后，共有 480 例骨折符合纳入标准，其中 202 例（42%）采用闭合复位，278 例（58%）采用切开复位。在 2 个复位组中，患者的人口统计学和损伤特征相似。在进行倾向评分匹配后，延迟愈合（52% vs. 28%；OR：2.88，95%CI：1.97-4.22；P <0.0001）和僵硬（22% vs. 10%；OR：2.42，95%CI：1.42-4.13；P =0.0012）在切开复位组中明显更高。两组之间的感染或非愈合率（闭合复位组 3%，切开复位组 1%）没有差异。
本研究表明，与闭合复位治疗的病例相比，需要切开复位的中度移位肱骨外髁骨折更容易出现肘部僵硬和延迟愈合。基于这些原因，我们建议在中度移位的肱骨外髁骨折（如果能达到解剖关节复位）中，首先尝试闭合复位技术，以获得更好的患者结果。
