Fowles J V, Rizkallah R
Can Med Assoc J. 1976 Jan 24;114(2):125-31.
Poor results in treating fractures and dislocations about the elbow may be avoided if the surgeon is aware of the possible injuries, examines good radiographs of both elbows, and treats the injury promptly and appropriately. A displaced fracture of the lateral or medial condyle of the humerus should be suspected if there is a flake fracture of the adjoining metaphysis; open reduction and internal fixation give better results than closed reduction. A shear fracture of the capitulum humeri can only be seen on a lateral radiograph; excision of the fragment, followed by mobilization, is sufficient for a good functional result. Dislocation of the elbow in a child may avulse the medial epicondyle, which sometimes lodges in the joint; it is essential to recognize this and remove the fragment without delay to avoid early degenerative arthritis. An apparently isolated fracture of the ulna should alert the surgeon to the possibility of a dislocation of the radial head; the dislocation and the fracture must be reduced and stabilized to conserve elbow function.
如果外科医生了解肘部可能存在的损伤，仔细检查双肘的高质量X光片，并及时、恰当地处理损伤，那么就可以避免肘部骨折和脱位治疗效果不佳的情况。如果相邻干骺端有片状骨折，则应怀疑肱骨外侧或内侧髁有移位骨折；切开复位内固定比闭合复位效果更好。肱骨小头的剪切骨折只能在侧位X光片上看到；切除碎片，随后进行活动，足以获得良好的功能结果。儿童肘部脱位可能会撕脱内侧髁，内侧髁有时会嵌入关节内；必须认识到这一点并立即取出碎片，以避免早期退行性关节炎。明显孤立的尺骨骨折应提醒外科医生注意桡骨头脱位的可能性；必须复位并固定脱位和骨折，以保留肘部功能。
