改良克氏针交叉固定治疗儿童复杂肱骨髁上骨折

目的探讨闭合复位后改良三根克氏针交叉固定治疗儿童复杂肱骨髁上骨折的疗效。方法1998年2月～2004年9月收治的36例复杂肱骨髁上骨折患儿,行闭合手法复位后,采用改良克氏针交叉固定。C型臂监视下在肱骨髁外侧用两根平行的克氏针固定,然后在内侧交叉固定一根克氏针。固定内侧克氏针时,须在保护骨折不移位的情况下小心地伸直肘关节保护好尺神经。术后长臂石膏维持肘关节制动3～4周。结果所有患儿在术后均未出现医源性尺神经损伤。术后随访12～21个月(平均15．8个月),根据Flynn等的功能和美观的标准进行评价,根据美观标准：36例患儿中35例均为优良,满意率为97．2%；根据功能标准：所有患儿均符合满意标准。结论儿童复杂移位的肱骨髁上骨折,用改良的三根克氏针交叉固定疗效良好,而且可以避免尺神经损伤。     

多克氏针髓内固定治疗肱骨多段骨折

2006年3月～2010年2月,我们对12例肱骨多段骨折患者予以多枚克氏针髓内固定,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男8例,女4例,年龄18～65岁。右侧7例,左侧5例。均为闭合骨折;合并桡神经损伤2     

Treatment of proximal humeral fractures by intramedullary Kirschner wires.

BACKGROUND: This study is a retrospective analysis of a case series of 41 proximal humeral fractures treated by multiple intramedullary Kirschner (K) wires. METHODS: Forty-one proximal humeral fractures in patients aged 17 to 62 years were treated by closed intramedullary K-wires. There were 18 patients with the 2-part fractures, 11 with the 3-part fractures and 12 with the 4-part fractures according to Neer's classification. Patients were placed supine on the table, under general anesthesia. The arm was held vertically up by transolecranon traction, and the C-arm was kept parallel to the ground and opposite to the affected arm. A cortical window was created approximately 1.5 cm proximal to the olecranon fossa, by splitting the triceps. Under fluoroscopic control, multiple K-wires were introduced retrograde into the medullary cavity to reach the humeral head across the fracture. The wire tips were kept divergent to provide rotational stability at the fracture site. Postoperatively, the limb was supported in an arm sling. The patients were evaluated for pain, range of motion, strength, anatomic restoration, function of the involved limb, and radiographic union of fracture. RESULTS: An objective evaluation of the results using Neer's criteria showed 92.7% excellent to satisfactory results. Three patients developed painful shoulder-one from the 3-part and two from the 4-part fracture group. One patient from the 4-part group developed avascular necrosis of the humeral head. CONCLUSION: This surgical technique is effective for proximal humeral fractures. It is recommended for routine management of the 2-part and the 3-part fractures. For the 4-part fractures, it can be used in selected, young and active patients. An endoprosthesis is advised for the old, osteoporotic patients.     

Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children

Purpose: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Un certainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction andpinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures.Methods: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury.Results: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed 3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations.Conclusion: We present a large multicentre cohort study showing that crossed 3 Kirschner wires are associated with better maintenance of reduction than crossed 2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supra condylar fractures. We found significant variations in practice and compliance with the British Ortho paedic Association Standard for Trauma (BOAST) 11 guidelines.     

Vascular complications of supracondylar humeral fractures in children

The purpose of this study was to analyze the vascular complications of 24 children with supracondylar humeral fractures treated in two affiliated hospitals and to propose a management plan. Exploration and repair of the brachial artery were undertaken in 11 of the 24 cases in which the pulse did not resume following reduction of the fracture. The repaired vessels were found to be patent on follow-up. Angiography was performed in six of the 24 cases and resulted in improved management in comparison with cases in which no angiography was performed. We believe that intra-operative angiography and vascular repair are indicated in most cases in which a palpable pulse does not resume after fracture reduction.     

Neurovascular complications in supracondylar humeral fractures in children

In a retrospective study, 18 patients with neurovascular complications of supracondylar humeral fractures are presented. Adequate diagnosis, therapeutic procedures, and prognosis are discussed, together with a review of literature.     

Late results in supracondylar humeral fractures in children

The end results of supracondylar humeral fractures in 151 children after an average follow-up period of 15 years are presented. The relationship between the carrying angle and the functional result was analyzed. A deformity of the carrying angle was not felt by the patients to be a cosmetic handicap, and the functional results were not problematic. However, the least satisfactory subjective results in the series were associated with a decrease of the carrying angle by at least 10 degrees and with a significant proportion of the limitations of movement of the elbow joint.     

Late results in supracondylar humeral fractures in children

Summary The end results of supracondylar humeral fractures in 151 children after an average follow-up period of 15 years are presented. The relationship between the carrying angle and the functional result was analyzed. A deformity of the carrying angle was not felt by the patients to be a cosmetic handicap, and the functional results were not problematic. However, the least satisfactory subjective results in the series were associated with a decrease of the carrying angle by at least 10° and with a significant proportion of the limitations of movement of the elbow joint.

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Zusammenfassung Es werden die Spätresultate von 151 suprakondylären Humerusfrakturen bei Kindern nach durchschnittlich 15jähriger Beobachtung dargestellt. Beurteilt wurde die Beziehung des Tragewinkels zum funktionellen Resultat. Festgestellte Tragewinkeländerungen wurden von den Patienten kosmetisch als nicht störend empfunden und funktionell waren die Ergebnisse fast problemlos. Die subjektiv ungünstigsten Resultate und ein bedeutender Teil der Fälle mit eingeschränkter Ellenbogenbeweglichkeit waren jedoch mit einer Verminderung des Tragewinkels um wenigstens 10° verbunden.

     

Neurovascular complications in supracondylar humeral fractures in children

Summary In a retrospective study, 18 patients with-neurovascualr complications of supracondylar humeral fractures are presented. Adequate diagnosis, therapeutic procedures, and prognosis are discussed, together with a review of literature.

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Zusammenfassung In einer retrospektiven Analyse werden 18 Patienten mit neurovaskulären Komplikationen nach einer suprakondylären Humerusfraktur dargestellt. Adequate Diagnosestellung, therapeutische Möglichkeiten und Prognose werden diskutiert und eine Übersicht der Literatur wird gegeben.

     

多方向不稳定的儿童肱骨髁上骨折的治疗

目的探讨急诊手术内固定治疗多方向不稳定的儿童肱骨髁上骨折的疗效。方法对26例多方向不稳定肱骨髁上骨折患儿采用闭合或切开复位克氏针内固定,术后肘关节屈曲20°～40°位石膏托固定3周后逐步进行功能锻炼。结果26例均得到随访,时间12～50个月,26例均临床愈合,骨折愈合时间4～6周。肘关节功能评价：优23例,良2例,可1例。无畸形愈合、感染、活动受限等并发症发生。结论闭合复位克氏针内固定是治疗多方向不稳定的儿童肱骨髁上骨折的有效方法,尽早复位及稳定固定骨折端,可有效减少或避免并发症的发生,利于肢体功能的恢复。     

Clinical significance of anterior humeral line in supracondylar humeral fractures in children

IntroductionAnterior humeral line (AHL) location is commonly used to evaluate sagittal alignment after fracture reduction in children with supracondylar humeral fractures. However, the position of the AHL for acceptable fracture reduction has not been validated by clinical outcome. The purpose of this study was to investigate the relationship between the location of AHL and range of elbow motion.Patients and methodsWe retrospectively reviewed 101 children who underwent closed reduction and percutaneous pinning for Gartland type III supracondylar humeral fractures between January 2009 and June 2014. There were 67 boys and 34 girls, with a mean age of 7 years. The children were classified according to the location of the AHL three months postoperatively into five groups: anteriorly loss (n = 6), anterior third (n = 25), middle third (n = 47), posterior third (n = 21), and posteriorly loss (n = 2). Range of elbow motion was measured by attending paediatric orthopaedic surgeons with a goniometer. Clinical and radiographic outcomes were compared among the five groups.ResultsThe mean elbow extension angle was not significantly different among the groups (p = 0.21). However, children with AHL anterior to the capitellum had less elbow flexion angle (125.8° vs. 131.2°, p = 0.046) and less total range of elbow motion (128.3° vs. 135.7°, p = 0.048) than children with AHL crossing the capitellum. When the AHL crossed the capitellum, the elbow flexion angle and total range of elbow motion were significantly decreased in children with AHL crossing the anterior third of the capitellum. The Flynn criteria were not significantly different among the central three groups (p = 0.131). However, the Flynn criteria were significantly worse in children whose AHL missed the capitellum (p < 0.001). The mean Baumann angle measured 3 months postoperatively was not significantly different among the groups (p = 0.12).ConclusionsThese findings demonstrate that children with AHL crossing the middle and posterior thirds of the capitellum appear to have slightly better early elbow flexion and total range of elbow motion. AHL crossing the anterior third of the capitellum can be an underreduction that has similar elbow motion as AHL anterior to the capitellum. AHL posterior to the capitellum is a warning sign of overreduction and should be avoided.     

Femoral shaft fractures in children: technique of immediate treatment with supracondylar Kirschner wires and one-and-a-half spica cast

Sixty-five children between 3.5 and 12 years of age with femoral shaft fractures were treated with fixed traction using supracondylar Kirschner wires incorporated in a one-and-a-half spica cast. Medial angulation up to 15 degrees, lateral angulation up to 5 degrees, and overriding up to 2 cm have been accepted. Posterior and anterior angulations have been rejected. After an average 4-year follow-up, neither joint stiffness nor skeletal deformity developed. At follow-up, maximal shortening was 0.8 cm, and overgrowth was 0.5 cm. Except for complicated cases, the use of this method is justified.     

Reproducibility of the Gartland classification for supracondylar humeral fractures in children

PURPOSE: To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification for supracondylar humeral fractures in children. METHODS: Anteroposterior and lateral radiographs of 50 supracondylar humeral fractures in children were graded on 2 separate occasions by 4 orthopaedic surgeons according to the Wilkins modification of the Gartland classification. Data were analysed by calculating the Kappa values for intra- and inter-observer agreement to indicate the reproducibility of the classification. RESULTS: There was moderate inter-observer agreement, except for poor agreement over type I fractures. Type II fractures only showed fair to moderate agreement. Type III fractures and the flexion group showed good to very good agreement. Intra-observer agreement was good to very good. CONCLUSION: Surgeons should treat paediatric supracondylar humeral fractures based on an assessment of the degree of displacement rather than by employing the Gartland classification.     

Pitfalls of lateral external fixation for supracondylar humeral fractures in children

Introduction  

Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures.     

Paediatric humeral supracondylar fractures

The supracondylar humeral fracture is the most common elbow fracture in children, accounting for just under one-fifth of all paediatric fractures and 60% of paediatric elbow fractures. Modifications of the Gartland classification have been made over the years. The mainstay treatment option is that of closed reduction and percutaneous wiring. However, there remains no gold standard in the management of this injury. Outcomes from other treatment options, including traction and external fixator application have been described and report good results. There remains controversy in the wiring configuration used, and there is no consensus on the approach to be used when faced with an irreducible fracture. This article aims to provide an up-to-date overview of the current practices in the management of this common injury, including the ‘pink pulseless’ hand, ‘poorly perfused white’ hand, surgical techniques, and the associated complications that can ensue.     

Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children

In this study, we aim to evaluate the clinical and radiological results of children who were treated with four different surgical approaches. In our clinics between February 2004 and November 2012, the children who underwent surgical treatment for supracondylar humeral fractures and whose data were available with regular follow-up of at least 1 year were included in the study. Clinical outcomes were evaluated for 54 patients with Gartland type 3 extension supracondylar fractures. Functional and cosmetic results of the patients were determined according to the Flynn criteria. Mean age of the patients was 4.9 (between 2 and 14) among which 26 of them were girls and 28 were boys. Mean operation time was 45 (35–85) min. Average length of hospital stay (LHS) was 2.9 (1–7) days. Average duration of splints was 3.5 (2–6) weeks, while the average removal period of the wires was 4.6 (3–8) weeks. Mean consolidation time was 4.6 weeks (3–8). Mean follow-up was 14.36 months. In our study, we performed 54 patients functional and cosmetic results. While 48 of the patients had satisfying results (excellent, good, or fair), six of them had unsatisfactory (poor) results. The results of this study suggest that clinical results with surgical treatment of Gartland type 3 extension fractures were satisfactory. However, the delay in the surgical treatment may cause a number of complications.