Department of Orthopaedics and Traumatology, Kartal City Hospital, Istanbul-Türkiye.
Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Nov;30(11):821-827. doi: 10.14744/tjtes.2024.04561.
Lateral condyle fractures are the second most common peri-elbow fractures in children aged 6-10 years, following supracondylar fractures. In treating these fractures, either open or closed reduction fixation can be performed. However, it is not yet completely clear which type of fracture should be treated and how. The Song classification has been increasingly used by orthopedic surgeons for these fractures in recent years. A review of the literature reveals few studies comparing closed reduction and percutaneous pinning (CRPP) and open reduction and internal fixation (ORIF) in lateral condyle fractures (LCFs) with displacements of 2 mm or more. Based on this, we compared Song stage 4 and 5 fractures operated with open or closed reduction methods in our clinic in terms of radiological and clinical aspects.
Patients who underwent surgery in our clinic for Song type 4 and 5 lateral condyle fractures between 2011 and 2016 were included in the study. After obtaining approval from our ethics committee (ID: 00171379117), we retrospectively evaluated the medical records of the patients. Between 2011 and 2016, 213 patients underwent surgery for LCF in our hospital, 24 patients were lost to follow-up, and 78 patients had other types of Song fractures. Our study evaluated 111 patients, who were divided into two groups: the CRPP group and the ORIF group.
A total of 111 patients were included in our study, with 52 undergoing CRPP and 59 undergoing ORIF. There was no difference between the groups in terms of age, gender, side of injury, mechanism of trauma, and follow-up time (p=0.962, p=0.198, p=0.706, p=0.526, p=1.000, p=0.708, respectively). There was also no significant difference in the displacement amounts between the patients (p=0.233). In the postoperative radiological comparison, a lateral spur was observed in 12 patients (23%) in the CRPP group and 28 patients (47.5%) in the ORIF group. Hardacre's criteria were evaluated as excellent in 46 (88.4%) of the patients who underwent CRPP and 50 (84.7%) of the patients who underwent ORIF. No significant result was found between both groups (p=0.769). There was no difference in complications between the groups (p=1.000).
This study demonstrates that in pediatric patients with lateral condyle fractures displaced by 2 mm or more, the choice between open or closed reduction has minimal impact on medium and long-term outcomes. Since there are not many studies on this subject in the literature, we believe that our results will provide valuable guidance for treatment decisions.
在 6-10 岁儿童中，外侧髁骨折是仅次于髁上骨折的第二常见肘部周围骨折。治疗这些骨折可以采用切开复位内固定或闭合复位内固定。然而，对于哪种类型的骨折应该采用哪种治疗方法，目前还不完全清楚。近年来，骨科医生越来越多地使用 Song 分类来治疗这些骨折。文献回顾发现，很少有研究比较过对于有 2 毫米或以上移位的外侧髁骨折（LCF），采用闭合复位经皮钢针固定（CRPP）和切开复位内固定（ORIF）的效果。基于此，我们比较了我院采用切开或闭合复位方法治疗的 Song 4 型和 5 型外侧髁骨折患者在影像学和临床方面的情况。
我们将 2011 年至 2016 年在我院接受手术治疗的 Song 4 型和 5 型外侧髁骨折患者纳入研究。在获得我院伦理委员会的批准（ID：00171379117）后，我们回顾性地评估了患者的病历。在 2011 年至 2016 年期间，我院共有 213 例 LCF 患者接受了手术治疗，其中 24 例失访，78 例患者有其他类型的 Song 骨折。我们的研究共评估了 111 例患者，将他们分为两组：CRPP 组和 ORIF 组。
共有 111 例患者纳入我们的研究，其中 52 例行 CRPP，59 例行 ORIF。两组在年龄、性别、损伤侧、创伤机制和随访时间方面无差异（p=0.962，p=0.198，p=0.706，p=0.526，p=1.000，p=0.708）。两组患者的移位量也无显著差异（p=0.233）。在术后影像学比较中，CRPP 组中有 12 例（23%）患者出现外侧骨赘，ORIF 组中有 28 例（47.5%）患者出现外侧骨赘。CRPP 组中 46 例（88.4%）患者和 ORIF 组中 50 例（84.7%）患者的 Hardacre 标准评估结果为优秀。两组间无显著差异（p=0.769）。两组间并发症无差异（p=1.000）。
本研究表明，对于有 2 毫米或以上移位的儿童外侧髁骨折，切开或闭合复位的选择对中远期结果的影响很小。由于文献中关于这个问题的研究并不多，我们相信我们的结果将为治疗决策提供有价值的指导。
