Ippolito E, Caterini R, Scola E
J Bone Joint Surg Am. 1986 Mar;68(3):333-44.
From a pool of 131 supracondylar fractures of the humerus in 131 patients who were treated conservatively, all of which healed in an average time of 4.5 weeks without complications related to the treatment itself, the cases of fifty-three patients were reviewed at maturity. The average age at follow-up was twenty-six years. Nine patients had unimportant limitation of elbow motion, and slight atrophy of the musculature of the arm or forearm, or of both, was present in six patients. Arm-length discrepancy was never observed. The carrying angle remained at about the same value that had been present at the time of fracture-healing in eighteen patients, decreased in twenty-two patients, and increased in thirteen. Malrotation of the distal fragment of the fracture only rarely caused medial tilting of the fragment with consequent cubitus varus. Varus deformity was present in four patients and valgus deformity, in three. None of the patients with valgus deformity had ulnar-nerve palsy. According to our results, varus and valgus deformities of the elbow after supracondylar fractures of the humerus seem to be caused either by growth imbalance of the growth plate of the distal end of the humerus (four patients) or by malreduction of the fracture (three patients). Twelve patients in the entire pool had neurological complications at the time of the fracture. Ten of those patients fully recovered from the deficit, whereas two--one with a radial-nerve deficit and the other with ulnar-nerve involvement--still had neurological impairment at follow-up.
在131例接受保守治疗的肱骨髁上骨折患者中，所有骨折均在平均4.5周内愈合，且未出现与治疗本身相关的并发症。对其中53例患者的病例进行了随访。随访时的平均年龄为26岁。9例患者肘关节活动有轻微受限，6例患者出现上臂或前臂或两者的肌肉轻度萎缩。未观察到臂长差异。18例患者的提携角保持在骨折愈合时的大致相同值，22例患者的提携角减小，13例患者的提携角增大。骨折远端的旋转畸形仅很少导致骨折块向内侧倾斜并继发肘内翻。4例患者出现内翻畸形，3例患者出现外翻畸形。外翻畸形患者均无尺神经麻痹。根据我们的结果，肱骨髁上骨折后肘关节的内翻和外翻畸形似乎要么是由肱骨远端生长板生长不平衡引起（4例患者），要么是由骨折复位不良引起（3例患者）。在整个病例组中，12例患者在骨折时出现神经并发症。其中10例患者的神经功能缺损完全恢复，而2例患者——1例有桡神经缺损，另1例有尺神经受累——在随访时仍有神经功能障碍。
