Ryan Patrick M, Startzman Ashley
Baylor Scott and White Medical Center, Department of Orthopaedic Surgery, Temple, TX.
J Pediatr Soc North Am. 2024 Feb 12;5(2):665. doi: 10.55275/JPOSNA-2023-665. eCollection 2023 May.
Supracondylar humerus fractures are common injuries encountered by orthopaedic surgeons. Closed reduction and percutaneous pin fixation is classically considered the standard of care treatment for these injuries, as this treatment method minimizes trauma to the soft tissues, are associated with few complications, and have a high rate of success. However, loss of fixation, when occurring, can lead to cosmetic, functional, and neurological complications. We present a case study of a displaced supracondylar humerus fracture initially treated with three lateral divergent pins that lost fixation and underwent subsequent surgical revision. •Failure to engage both the fracture fragment and the intact proximal shaft may lead to loss of fixation.•Rotating the fluoroscopy machine while keeping the elbow fixed allows for obtaining intraoperative imaging while minimizing the risk of fracture displacement or subsequent loss of fixation.•A trans-olecranon pin may be a helpful reduction tool in significantly unstable fracture patterns.•Casting should be considered for postoperative immobilization in Gartland Type III or Gartland IV fractures.
肱骨髁上骨折是骨科医生常见的损伤。闭合复位经皮穿针固定传统上被认为是这些损伤的标准治疗方法，因为这种治疗方法能使软组织创伤最小化，并发症少，成功率高。然而，固定失败一旦发生，可导致外观、功能和神经方面的并发症。我们报告一例移位肱骨髁上骨折的病例研究，该患者最初采用三根外侧发散针治疗，出现固定失败，随后接受了手术翻修。
•未能同时固定骨折块和完整的近端骨干可能导致固定失败。
•在保持肘部固定的同时旋转透视机，可在术中进行成像，同时将骨折移位或随后固定失败的风险降至最低。
•对于明显不稳定的骨折类型，经鹰嘴穿针可能是一种有用的复位工具。
•对于Gartland III型或Gartland IV型骨折，术后应考虑使用石膏固定。
