Weise K, Schwab E, Scheufele T M
Berufsgenossenschaftliche Unfallklinik Tübingen.
Unfallchirurg. 1997 Apr;100(4):255-69. doi: 10.1007/s001130050117.
Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in sport and play activities, e.g., a fall from gymnastics apparatus or a bike, or from popular sports items, such as skateboards or in-line skates. The injuries can be divided into pure dislocations of the joint and fractures of the distal humerus, proximal radius and ulna, or combinations of both. In addition, extra- and intraarticular fracture types are defined, with the latter as partial or complete joint lesions. Dislocations of the elbow joint or the radial head can occur as single injuries or in combination with a fracture. Supracondylar fractures and avulsion fractures of the medial epicondyle are the most frequent extraarticular lesions of the distal humerus. Fractures of the lateral condyle prevail is incomplete intraarticular lesions. In the forearm, radial head and neck fractures are predominant while typical and atypical Monteggia injuries have a special status. The complex joint construction and the age-dependent appearance of the epiphyseal ossification centers sometimes make a correct radiological diagnosis difficult. The trauma history and an exact, clinical examination help to verify the injury, as do comparative X-ray studies of the uninjured side when necessary (but not routinely). Unlike other anatomical areas, most elbow injuries-even in the growing skeleton-are treated operatively. Hereby, the growth plates have to be respected using minimal amounts of small implants. Additional immobilization in a cast for 2-4 weeks is necessary in most cases but does not lead to a functional deficit-in contrast to adults. The implants should be removed as early as possible. Despite all therapeutic efforts, a significant number of late sequelae, such as malunions and functional impairment, can be seen. The rate of long-term complications increases in cases of untreated displacement of fragments or joint instability. Corrective measures are performed only in selected cases and after the growth plates are closed. Our own treatment regime is demonstrated using exemplary clinical cases of the different injuries and the results of a long-term follow-up study on sports injuries of the elbow in children. Errors in diagnosis and therapy, as well as possible complications, are pointed out.
肘部骨折和脱位是儿童及青少年时期最常见的损伤之一。大多数损伤发生在体育活动和玩耍中，例如从体操器械、自行车上摔下，或从滑板、轮滑鞋等热门体育用品上摔下。这些损伤可分为单纯关节脱位、肱骨远端骨折、桡骨近端骨折和尺骨骨折，或两者的组合。此外，还定义了关节外和关节内骨折类型，后者为部分或完全关节损伤。肘关节或桡骨头脱位可单独发生，也可与骨折合并发生。肱骨髁上骨折和内上髁撕脱骨折是肱骨远端最常见的关节外损伤。外侧髁骨折以不完全关节内损伤为主。在前臂，桡骨头和颈部骨折最为常见，而典型和非典型孟氏骨折具有特殊地位。复杂的关节结构以及骨骺骨化中心随年龄的出现有时会使正确的放射学诊断变得困难。外伤史和准确的临床检查有助于确诊损伤，必要时（但非常规）对未受伤侧进行X线对照检查也有帮助。与其他解剖部位不同，大多数肘部损伤——即使是在骨骼生长阶段——都采用手术治疗。因此，必须使用少量小型植入物，同时要注意保护生长板。在大多数情况下，需要额外用石膏固定2至4周，但与成人不同的是，这不会导致功能缺陷。植入物应尽早取出。尽管采取了所有治疗措施，但仍可出现大量晚期后遗症，如畸形愈合和功能障碍。骨折碎片未处理的移位或关节不稳定的情况下，长期并发症的发生率会增加。仅在特定病例且生长板闭合后才采取矫正措施。我们通过不同损伤的典型临床病例以及对儿童肘部运动损伤的长期随访研究结果，展示了我们自己的治疗方案。同时指出了诊断和治疗中的错误以及可能出现的并发症。
