Zouirech Yacine, Manni Abir, Aqqaoui Loubna, Oubejja Houda, Hosni Sarah, Ettayebi Fouad
Department of Pediatric Surgical Emergency, Ibn Sina University Hospital Center, Children's Hospital of Rabat, Morocco; Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco.
Department of Pediatric Surgical Emergency, Ibn Sina University Hospital Center, Children's Hospital of Rabat, Morocco; Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco.
Int J Surg Case Rep. 2025 Jun;131:111295. doi: 10.1016/j.ijscr.2025.111295. Epub 2025 Apr 12.
Shear capitellum fractures (CFs) are rare, particularly in pediatric populations, and pose significant diagnostic challenges due to the high cartilaginous content of the developing elbow. These injuries often involve small osteochondral fragments that may escape detection on standard radiographs, requiring a high index of clinical suspicion. Timely and appropriate surgical management is crucial to prevent long-term complications. This case series presents the outcomes of four adolescents with displaced CFs treated by ORIF using Kirschner wires (K-wires) in three cases and a spongy screws in one case, highlighting the reliability of K-wires fixation, especially in resource-limited settings.
We retrospectively reviewed four adolescents (3 boys, 1 girl; mean age: 13.5 years) treated for displaced CFs at our Pediatric Emergency Department between 2019 and 2024. Three injuries followed falls on an extended elbow and one on a flexed elbow. One case was associated with an ipsilateral elbow dislocation. Fractures were classified as Type I (two cases) and Type IV (two cases). ORIF was performed using K-wires (three cases) or a spongy screw (one case) via lateral (two cases) or posterolateral (two cases) approaches. Postoperative care included four weeks of immobilization in 90° flexion using a posterior brachio-antebrachial (BAB) splint, followed by progressive mobilization and physiotherapy in two cases. At a mean follow-up of 18 months (range: 12-24), all patients achieved bone union within 6-8 weeks. K-wires were removed at six weeks and the screw at six months. Full pronation and flexion were regained, with only minor residual limitations in extension and supination in two patients. Functional outcomes were excellent, with a mean MEPI score of 100. No complications were observed, and all patients and their families expressed satisfaction with the results.
CFs in adolescents are uncommon and frequently overlooked due to subtle radiological findings. When clinical suspicion is high, advanced imaging such as CT is invaluable for accurate diagnosis. ORIF via lateral or posterolateral approaches using K-wires or screws provides stable anatomical reduction and preserves joint function. K-wires fixation remains a practical and effective option, particularly in low-resource settings.
Early diagnosis and surgical management are essential in treating displaced CFs in adolescents. This series supports the effectiveness of K-wires fixation in restoring joint integrity and achieving excellent functional outcomes, underscoring its value in resource-constrained environments.
肱骨小头剪切骨折（CFs）较为罕见，在儿童群体中尤其如此，由于发育中的肘部软骨含量高，给诊断带来了重大挑战。这些损伤常涉及小的骨软骨碎片，在标准X线片上可能难以发现，需要高度的临床怀疑指数。及时且恰当的手术治疗对于预防长期并发症至关重要。本病例系列展示了4例青少年移位性CFs的治疗结果，其中3例采用克氏针（K针）切开复位内固定（ORIF），1例采用松质骨螺钉，突出了K针固定的可靠性，尤其是在资源有限的环境中。
我们回顾性分析了2019年至2024年期间在我院儿科急诊科接受治疗的4例青少年移位性CFs患者（3例男性，1例女性；平均年龄：13.5岁）。3例损伤是在伸直肘部摔倒后发生，1例是在屈曲肘部摔倒后发生。1例伴有同侧肘关节脱位。骨折分类为I型（2例）和IV型（2例）。通过外侧（2例）或后外侧（2例）入路，采用K针（3例）或松质骨螺钉（1例）进行ORIF。术后护理包括使用后侧臂-前臂（BAB）夹板在90°屈曲位固定4周，随后2例患者进行逐步活动和物理治疗。平均随访18个月（范围：12 - 24个月），所有患者均在6 - 8周内实现骨愈合。K针在6周时取出，螺钉在6个月时取出。所有患者均恢复了完全旋前和屈曲功能，仅2例患者在伸展和旋后方面有轻微残留受限。功能结果极佳，平均MEPI评分为100分。未观察到并发症，所有患者及其家属对结果表示满意。
青少年CFs并不常见，由于影像学表现不明显，常被忽视。当临床怀疑度高时，CT等高级影像学检查对于准确诊断非常重要。通过外侧或后外侧入路使用K针或螺钉进行ORIF可提供稳定的解剖复位并保留关节功能。K针固定仍然是一种实用且有效的选择，尤其是在资源匮乏的环境中。
早期诊断和手术治疗对于青少年移位性CFs的治疗至关重要。本系列支持K针固定在恢复关节完整性和实现极佳功能结果方面的有效性，强调了其在资源受限环境中的价值。
