Kekomäki M, Luoma R, Rikalainen H, Vilkki P
J Pediatr Orthop. 1984 Jan;4(1):13-5. doi: 10.1097/01241398-198401000-00003.
We evaluated the results of the operative treatment of a difficult supracondylar fracture of the elbow. A series of 45 consecutive children, the majority presenting initially with a complete dislocation of the humerus, was reexamined. Thirty-two of the patients had undergone an early operation applying the anterior cubital approach and 13 patients had been treated by traction. The lengths of the follow-up periods were 3.1 +/- 1.5 and 8.8 +/- 2.6 years, respectively. Normal range of extension-flexion and rotation movements was preserved almost invariably by either modality of therapy, whereas the carrying angle of the elbow was reduced significantly more often in the group treated by traction. None of the patients presented with permanent nerve dysfunction, keloid formation, or myositis ossificans. The two preventable early complications, slipping of the osteosynthesis and entrapment of the ulnar nerve, were related to the fixation of the fracture. There were no early or late infectious complications. When the anterior approach was used, operative reduction and fixation of a difficult supracondylar fracture of the humerus proved to be both safe and timesaving. Anatomical results of operation were superior to those attained by traction therapy in our series.
我们评估了难处理的肱骨髁上骨折的手术治疗结果。对连续45例儿童进行了复查，大多数患儿最初表现为肱骨完全脱位。其中32例患者采用肘前入路进行了早期手术，13例患者接受了牵引治疗。随访时间分别为3.1±1.5年和8.8±2.6年。两种治疗方式几乎都能使屈伸和旋转运动保持正常范围，而牵引治疗组的肘提携角明显减小更为常见。所有患者均未出现永久性神经功能障碍、瘢痕疙瘩形成或骨化性肌炎。两种可预防的早期并发症，即骨固定移位和尺神经卡压，均与骨折固定有关。未出现早期或晚期感染并发症。当采用前入路时，肱骨髁上难处理骨折的手术复位和固定被证明既安全又省时。在我们的系列研究中，手术的解剖学结果优于牵引治疗。
