Kumar Amit, Keshav Kumar, Baghel Anurag, Singh Anoop Raj, Rai Alok, Sharma Pulak
Department of Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Orthopaedics, Shaikh-Ul-Hind Maulana Mahmood Hasan Medical College, Saharanpur, Uttar Pradesh, India.
J Orthop Case Rep. 2025 Jul;15(7):248-254. doi: 10.13107/jocr.2025.v15.i07.5840.
Traditionally displaced supracondylar fractures of the humerus are treated by percutaneous pinning and above-elbow slab/cast support. Crossed pinning is commonly used as it provides better biomechanical stability than lateral pinning. The fracture is often associated with a high risk of complications such as neurovascular injury, pulselessness, and the development of swelling or compartment syndrome in acute scenarios. These clinical conditions require regular examination of neurovascular structures and forearm swelling, which is difficult with a slab or cast. Post-surgery Slab or cast has been found to be associated with elbow stiffness, which significantly increases in older children. Here we are presenting an innovative fixation method for such fracture.
This retrospective study examined the clinical, radiological, and functional results of ten patients who had displaced supracondylar humerus fractures treated with our novel Arc fixator.
6 out of 10 patients (mean age: 8.2 years; 6-12 years) had a fracture of the non-dominant limb. Flexion injury was seen in one patient with transient ulnar nerve palsy. 3 patients who had injury-related nerve palsy (median 2/ulnar 1), recovered spontaneously at 3 months. Fracture union was observed in all at 6 weeks. All patients achieved a near-normal range of motion (ROM) without deformity at the final follow-up. They had satisfactory scores at 3 months according to Flynn criteria.
The construct was found stable and rigid enough to provide fracture stability and allow intermittent ROM exercises. This new method of fixation has the added advantage of regular examination of forearm and neurovascular structures in the postoperative period and allowing early elbow function of the patient, along with being patient-friendly.
传统上，肱骨髁上移位骨折采用经皮穿针及肘上石膏托/石膏固定治疗。交叉穿针常用，因为它比外侧穿针提供更好的生物力学稳定性。骨折常伴有高并发症风险，如急性情况下的神经血管损伤、无脉症以及肿胀或骨筋膜室综合征的发生。这些临床情况需要定期检查神经血管结构和前臂肿胀情况，而使用石膏托或石膏很难做到。术后发现石膏托或石膏与肘关节僵硬有关，在大龄儿童中这种情况会显著增加。在此，我们介绍一种针对此类骨折的创新固定方法。
这项回顾性研究检查了10例采用我们新型弧形固定器治疗肱骨髁上移位骨折患者的临床、放射学和功能结果。
10例患者中有6例（平均年龄：8.2岁；6 - 12岁）为非优势肢体骨折。1例患者为屈曲损伤，伴有短暂性尺神经麻痹。3例有与损伤相关神经麻痹的患者（正中神经2例/尺神经1例）在3个月时自发恢复。所有患者在6周时均观察到骨折愈合。在最终随访时，所有患者均实现了接近正常的活动范围（ROM）且无畸形。根据弗林标准，他们在3个月时得分满意。
发现该结构足够稳定和坚固，能够提供骨折稳定性并允许进行间歇性ROM锻炼。这种新的固定方法的额外优势在于术后可定期检查前臂和神经血管结构，并使患者能早期恢复肘关节功能，而且对患者友好。
