Chalidis Byron, Rigkos Dimitrios, Giouleka Sonia, Pitsilos Charalampos
1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.
Obstetrics and Gynaecology Department, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK.
J Clin Med. 2025 Mar 17;14(6):2037. doi: 10.3390/jcm14062037.
: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. : A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. : Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1-46 months) with a mean follow-up of 37 months (range: 0.5-516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension-flexion arc was 2.1° to 127.8° (range: -10-140°). The mean Bauman's angle was 72.4° (range: 66-79°), the mean shaft-condylar angle was 43.8° (range: 25-59°), the mean humeral length was 21.9 cm (range: 15.5-25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus-19° valgus). According to Flynn's criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome ( = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction ( = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction ( < 0.001). : Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate.
肱骨远端骨骺分离（DHPS）在幼儿中是一种罕见的损伤类型，常伴有误诊和治疗延迟。本研究的目的是总结目前关于DHPS治疗及预后的所有现有证据，并确定并发症的发生率，尤其是肘内翻畸形和滑车缺血性坏死的发生率。：按照PRISMA指南进行系统评价。在Medline/Pubmed、Scopus、Web of Science和Cochrane数据库中检索关于患有创伤性DHPS儿童的研究。：纳入12项研究，共257例DHPS患儿进行分析。平均年龄为16.8个月（范围：0.1 - 46个月），平均随访37个月（范围：0.5 - 516个月）。17.2%的病例报告为非意外创伤，初次评估时误诊率为7.8%。54.4%的病例选择闭合复位经皮穿针固定（CRPP）治疗，26.5%选择切开复位经皮穿针固定（ORPP），10.9%选择闭合复位石膏固定（CR + 石膏），8.2%选择未复位的石膏固定。屈伸弧平均范围为2.1°至127.8°（范围： - 10 - 140°）。平均鲍曼角为72.4°（范围：66 - 79°），平均骨干 - 髁上角度为43.8°（范围：25 - 59°），平均肱骨长度为21.9 cm（范围：15.5 - 25.8 cm），平均提携角为5.1°（范围：内翻16° - 外翻19°）。根据弗林标准，85.2%的病例被分类为优或良。ORPP技术效果极佳而CR + 石膏治疗组合预后最差（P = 0.001）。18.9%（34例）出现肘内翻，与CR + 石膏或单纯未复位的石膏固定高度相关（P = 0.014）。3.9%（7例）发现滑车缺血性坏死，主要出现在未复位石膏固定后（P < 0.001）。：创伤后肘内翻畸形在约五分之一的DHPS幼儿中可能出现。采用CRPP或ORPP的手术干预是最有效的治疗方法，能带来更好的功能预后和更低的并发症发生率。
