肱骨远端肱骺角测量的临床意义

Ｂａｕｍａｎｎ氏在１９２９年提出测量肱骨干长轴与肱骨小头骨骺线外侧夹角（简称肱骺角）,可用于判定肱骨髁上骨折后肘内翻畸形的程度〔１〕。但Ｂａｕｍａｎｎ氏角对拍片的位置要求较高。近几年我们在实践中发现,肱骺角在正位Ｘ线片上基本不受肘关节屈伸角度的影响。...     

儿童肘关节X线片中的肱桡关系

目的　研究肘关节X线片中肱桡关系划线是否中断作为诊断儿童肘部损伤的重要参考依据。方法　报道 2 1例 2～ 8岁儿童的 42肘正常肘关节X线片 5 4张 ,在摄前后位和侧位X线片时分别采用不同位置 ,划线得出与肱骨小头中心相交、非中心相交、相切、相离的不同结果。结果　正位X线片中 ,桡骨颈纵轴延长线与肱骨小头骨骺中心相交仅仅出现在标准位即前臂旋后 90°时 ,其它位置均出现非中心相交 ,相切或相离 ,侧位X线片中 ,中心相交出现在肘关节屈曲 6 0°～ 12 0°位置。结论　儿童肘部损伤时 ,由于难于配合或投照因素 ,临床医师不得不接受大量非标准位X线片 ,肱桡关系划线非中心相交时 ,必须考虑上述因素 ,避免误诊、漏诊。     

Southwick角和Klein线在股骨头骺滑脱诊断中的作用

[目的]探讨Southwick角和Klein线在股骨头骺滑脱诊断中的作用。[方法]回顾性分析1995年8月～2006年4月,本科所收治并获得随访的SCFE病例42例,其中男30例,女12例;平均年龄10.4岁。分析患儿的标准前后位双髋正位和双髋蛙式侧位片。在正位X线片上观察股骨头骺板是否增宽和不规则,测量Southwick角,绘制Klein线。在侧位X线片上测量外侧骺干角,绘制Klein线。[结果]所有患者均出现股骨头骺板增宽和不规则。Southwick角随着滑脱程度加重而减少。正侧位Klein线阳性率均随着严重程度加重而增加,但是正位Klein线在轻中度滑脱组中阳性率不高,侧位Klein线在全部组中阳性率均高。[结论]Southwick角和Klein线在SCFE的诊断中具有重要作用,尤其是要重视髋关节侧位片在诊断中的作用。     

儿童肱骨远端骨骺分离骨折的肘关节造影分度探讨

目的 根据儿童肱骨远端骨骺分离骨折的肘关节造影表现，从正位X线片和侧位X线片的测量结果提出笔者的造影分度标准。方法 自2015年1月至2017年6月，西北妇女儿童医院骨科收治23例肱骨远端骨骺分离骨折的患儿，其中男17例，女6例；年龄9～42个月，平均(19.43±8.31)个月；左侧9例，右侧14例。按Salter-Harris分型，Ⅰ型6例，Ⅱ型17例。按DeLee分型，A型3例，B型19例，C型1例。均采用术中肘关节造影检查，观察肱骨远端与近端的移位及成角情况。在正位X线片上测量移位的距离与肱骨远端骨骺宽度的百分比来反映移位的程度。在侧位X线片上测量肱骨远端与近端成角的具体数值。结果 根据测量结果提出笔者的造影分度标准，轻度：正位骨折向内移位比例<30%,或侧位骨折向后成角<20°;中度：正位30%≤骨折向内移位比例<60%,或20°≤侧位骨折向后成角<40°;重度：正位骨折向内移位比例≥60%,或侧位骨折向后成角≥40°。23例患儿肱骨远端向尺侧移位比例为17%～100%,平均(39±7)%。肱骨远端向后成角14°～51°,平均(32±11)°。按照笔者...     

儿童肱骨远端全骺分离的X线诊断与临床意义

目的分析儿童肱骨远端全骺分离的X线表现,提高诊断率。方法回顾收集并分析26例小儿肱骨远端全骺分离的X线平片资料。结果本组26例儿童肱骨远端全骺分离均为Salter-HarrisⅡ型骨骺损伤。X线表现为小儿肱骨远端内侧干骺端有一骨块向尺侧和内上方移位,肱骨远端骨骺与尺桡骨近端一道向后内侧同步移位,桡骨小头与肱骨小头骨骺关系不变。结论肱骨远端骨骨骺一道同歩移位,与尺桡骨近端保持正常解剖位置关系,具有诊断意义。     

青少年肱骨远端半小头骨折八例

肱骨远端半小头骨折临床上少见,1986～1996年我们共收治8例,报告如下。 1 临床资料 1.1 一般资料 本组男5例,女3例;左侧4例,右侧4例;发病年龄13～17岁,平均13.7岁。临床表现:8例均有明显的关节肿胀,关节内有异常活动及骨擦音,4例肘内侧有压痛及淤血斑,肘前能触到活动的骨折块,4例肘关节活动受限约30～40°。X线片正位片常不能清晰显示骨折块影像,侧位片可显示骨折块位于肱骨髁前上方。(图1)     

肱骨上下端骨骺两极骨析2例

例1 男,14岁。于1985年1月因高处摔下致左肩、肘部外伤15天入院。查体:左肩、肘部肿胀、畸形,活动受限。X线摄片示左肱骨上端骨骺、肱骨远端骨骺、髁间骨折,且移位明显。入院后行左肱骨上端与下端骨骺骨折切开复位、克氏针内固定术。随访8年,左上臂长度及肩、肘关节功能均正常。X线片示左肱骨头和内外髁比对侧膨大。     

儿童肱骨外髁骨折骨不连的治疗

目的 探讨儿童肱骨外髁骨折骨不连的治疗方法.方法 对13例肱骨外髁骨折骨不连进行诊治.患几年龄平均10.5岁(6～14岁),受伤至就诊时间平均6.7年(0.9～10年).其中Milch Ⅰ型3例(X线片表现为肱骨外髁骨块较小、桡骨小头呈圆形、肱骨小头凹陷),Milch Ⅱ型10例(X线片表现为肱骨外髁骨块较大、肱桡关节结构近似正常).13例中行单纯骨折切开复位内固定术1例,游离髂骨植骨内固定术3例,游离髂骨植骨内固定+尺神经松解前置术1例,游离髂骨植骨内固定+肱骨髁上楔形截骨术5例,游离髂骨植骨内固定+肱骨髁上楔形截骨+尺神经松解前置术3例.结果 术后随访时间平均为5.6年(2.2～12年).除2例患者骨延迟愈合外,其余患者均达到骨愈合.术前疼痛症状及肘关节不稳消失.患手握力恢复至健侧的87%(84%～100%).3例肘关节屈伸活动度得到明显改善.平均改善47.7°(30°～58°);2例肘关节屈伸活动度无明显改善;8例肘关节屈伸活动度与术前相比有所下降,平均下降16°(8°～30°).13例中除2例肘外翻角度增加和2例继发肘内翻外,其余9例提携角平均下降14.2°.按Broberg肘关节功能评分系统评定:优7例,良6例;优良率为100%.结论 儿童肱骨外髁骨折骨不连可行外科手术治疗,骨折切开复位、植骨内固定术是确实且有效的治疗方法.     

腕部X线侧位片上泪滴角的测量及临床意义

目的分析测量正常成人腕部X线侧位片上泪滴角的正常值,为帮助临床诊断提供依据。方法对18~58岁双腕骨骺已闭合且无骨折及畸形的成人志愿者160例,320个腕关节进行研究,其中每个年龄组各4例,男女各2例,共40个年龄组。按不同的年龄段分A(18～28岁)、B(29~38岁)、C(39~48岁),D(49～58岁)4个组,每组40例80个腕关节。所有志愿者均摄标准侧位X线片,在受试者中每组随机选择10例,男、女各5例,取泪滴的中轴与桡骨干纵轴的的夹角为泪滴角。结果正常成年人侧位泪滴角平均为(68.72±4.39)°,不同性别及不同侧别泪滴角比较,差异均无统计学意义;泪滴角与年龄之间有显著相关性。结论测量所得X线侧位片泪滴角可用于腕部疾病,特别是桡骨远端关节内骨折的诊断参考指标。     

儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响分析

目的探讨儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响。方法回顾性分析2020年1月至2021年12月福州市第二医院小儿骨科收治的453例Gartland Ⅲ型伸直型肱骨髁上骨折患者资料, 所有患者均行闭合复位克氏针固定术。根据复位情况分为2组:残留旋转畸形组(A组)69例, 男44例, 女25例;年龄(6.3±2.9)岁;术中透视正位X线片上Baumann角维持在65°～80°, 侧位X线片上肱骨前缘线通过肱骨小头前1/3, 残留部分旋转畸形, 但提携角正常(4°～23°)。解剖复位组(B组)384例, 男242例, 女142例;年龄(5.9±2.7)岁;术中透视正、侧位X线片示骨折端解剖复位。记录并比较两组患者术中透视次数、手术时间、术中提携角、术后6个月提携角和术后6个月肘关节Flynn评分。结果两组患者性别、年龄、侧别、克氏针固定时间比较差异均无统计学意义(P> 0.05), 具有可比性。所有患者术后获(6.3±2.9)个月随访。A组患者术中透视中位次数[6 (4, 6)次]少于B组[8 (6, 8)次], 手术时间中位数[20 (20, 25) min]少于B组[30...     

The measurements and standardization of humerocondylar angle in children

BACKGROUND: Supracondylar fractures of the humerus in children are very common. However, the literature regarding measurements of normal anatomical relationships of the distal humerus in sagittal plane is sparse. METHOD: We reviewed the radiographs of normal elbow joints in 142 children treated in our hospital over 2 years. No history of previous trauma of distal humerus was found. The children were separated into 3 age groups (<5, 5-10, and 10-15 years old), and measurement of the humerocondylar angle (HCA) in sagittal plane was performed. RESULTS: The mean age of children in group 1 was 3 years 1 month; in group 2, 7 years 8 months; and in group 3, 12 years. There were 99 boys and 43 girls. The mean HCA was 41.6 degrees (range, 30-70 degrees). No statistically significant influence on HCA by age, sex, or side was found. We found a small number of extreme variants in HCA (down to 30 degrees and up to 70 degrees) in children without any history of previous trauma and having a normal range of elbow motion. CONCLUSIONS: We found that HCA is close to the well-accepted figure of 40 degrees. Interestingly, this value remains the same in all age groups. That means that the geometry of the distal humerus in sagittal plane is established very early during the growth and remains constant. Due to significant individual variations of HCA, it alone cannot be sufficient for final decisions in evaluation and treatment of supracondylar fractures.     

Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures

The aim of this study was to assess the correlation between the occurrence of iatrogenic ulnar nerve injury and frontal and saggital angular insertion of the medial pin in type 3 pediatric supracondylar humerus fractures treated by closed reduction and percutaneous fixation using a cross-pin configuration. Radiographs of 90 children were retrospectively reviewed and two radiographic parameters were measured. The frontal humerus-pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on an anteroposterior radiograph. The saggital humerus-pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on a lateral radiograph and expressed as positive and negative values if the insertion direction of the pin was anterior to posterior or posterior to anterior, respectively. There was a significant difference between the mean saggital humerus-pin angle values of ulnar nerve injury and no neurological complication groups (12.1 degrees versus 1.6 degrees , respectively; P=0.001). It was concluded that, anteroposterior insertion of the medial pin in the saggital plane, while the elbow was in hyperflexion, correlated with the occurrence of iatrogenic ulnar nerve injury.     

Assessment of Instant Loss of Elbow Flexion in Children with Untreated Gartland IIA Humeral Supracondylar Fractures—A Simulation Study with Lateral Elbow Radiographs

Objective

The suitability of in situ cast fixation for treating Gartland IIA humeral supracondylar fractures has remained controversial due to concerns regarding loss of elbow flexion. This study aimed to assess the instant loss of elbow flexion after Gartland IIA humeral supracondylar fractures based on the relationship between the anterior marginal line of the humerus and capitellum in the lateral view.

Methods

This simulation study was conducted with normal radiographs using Adobe Photoshop 14.0, followed by verification using clinical cases. Standard lateral views of normal elbows of children were collected from January 2008 to February 2020. Adobe Photoshop was used to simulate Gartland IIA supracondylar fractures with different degrees of angulation in the sagittal plane. A formula was deduced to assess flexion loss, and this method was verified in three cases. The data were grouped by age, and the relationship between elbow flexion loss and age, as well as the angulation of the fracture, was analyzed using a one-way or multivariate ANOVA.

Results

There was a flexion loss of 19° (11–30°) when the anterior margin line of the humerus was tangential to the capitellum. This loss increased with age at injury (r = 0.731, P = 0.000). Moreover, the difference in angulation in the sagittal plane also influenced the extent of elbow flexion loss (r = −0.739, P = 0.000). The more horizontal the fracture line in the lateral view, the greater the loss of elbow flexion.

Conclusion

Instant elbow flexion loss after Gartland IIA humeral supracondylar fractures increases with age at the time of injury and decreases with angulation in the sagittal plane. When the anterior margin of the humerus is tangential to the capitellum, there will be an average loss of 19° in elbow flexion. These findings provide a quantitative reference for clinical decision-making in the treatment of Gartland IIA supracondylar fractures.     

Pediatric elbow measurement parameters: Evaluation of the six angles in inter- and intra-observer reliability

BackgroundSeveral radiographic measurements of the humerus can be used to evaluate the treatment outcome of supracondylar fractures in children. Because of the cartilaginous nature of the immature elbow, interpretation of radiographs around this area is sometimes challenging and can be unreliable. This study was conducted to determine the inter-observer and intra-observer reliability of the six commonly used radiographic measurements of the distal humerus.MethodThe Baumann angle, humero-ulna angle, metaphyseal-diaphyseal angle, radial epiphyseal angle, shaft-condylar angle and lateral capitellohumeral angle of the humerus were measured by two observers on the radiographs of uninjured elbows from 58 children. The values between each measurement were compared and correlated using a Pearson coefficient of correlation to determine the inter-observer and intra-observer reliability.ResultsAll of the radiographic parameters showed excellent intra-observer reliability with the correlation coefficient values of the Baumann angle, humero-ulna angle, metaphyseal-diaphyseal angle, radial epiphyseal angle, shaft-condylar angle, lateral capitellohumeral angle as 0.945, 0.95, 0.909, 0.888, 0.961 and 0.975 (p < 0.001), respectively. The inter-observer reliability of the Baumann and humero-ulna angles were also found to be highly correlated at r = 0.843 (p < 0.001) and 0.878 (p < 0.001), respectively. The metaphyseal-diaphyseal angle had poor reliability with r = 0.136 (p = 0.291) while the radial epiphyseal angle, shaft-condylar angle, and lateral capitellohumeral angle demonstrated good reliability with r = 0.675 (p < 0.001), 0.747 (p < 0.001), and 0.686 (p < 0.001), respectively.ConclusionThe Baumann angle and humero-ulna angle measurements of distal humerus showed excellent inter- and intra-observer reliability. Both parameters represent repeatable and reliable methods for determining the outcome of supracondylar humeral fractures in pediatric population.     

Proximal humerus fractures in the pediatric population: a systematic review

Purpose  

Proximal humerus fractures and epiphyseal separations in skeletally immature children and adolescents are traditionally treated non-operatively. Recently, authors have described the operative fixation of these injuries, particularly in older children and adolescents with displaced fractures. We performed a systematic review of the literature to identify operative indications for proximal humerus fractures in children and to compare the results by age, displacement, and treatment modality.     

Functional outcome of supracondylar humerus fracture in children with the use of pin configuration as per Bahk classification

IntroductionA variety of fracture patterns are seen in supracondylar humerus fractures in children and these are well described by Bahk et al. Currently followed treatment protocol doesn’t recognize these common fracture patterns and pin placement is done at the discretion of the treating surgeon. The aim of the study is to evaluate the usefulness of Bahk classification system in deciding the pin configuration for the specific fracture patterns and thereby assess the functional outcome in the management of supracondylar fractures in children.MethodThe study was done on 100 children of 2–12 years of age from February 2019 to January 2020. After closed reduction under general anesthesia, fractures were classified and pin configuration was decided according to Bahk classification. In the follow-up, patients were assessed for clinicoradiological outcomes based on Modified Flynn’s criteria, Baumann angle, and anterior humeral line.ResultsIn our study Typical transverse and low sagittal fracture were the most common fracture patterns. In the final follow up as per Flynn’s criteria, 93% of the patients showed excellent results. Mean Baumann’s angle was not significantly different from the uninjured side and anterior humeral line passed through anterior or middle third of the capitulum in 95% patients.ConclusionUsing pin configuration suitable to fracture pattern as per Bahk classification improves functional outcome in supracondylar humerus fractures in children and minimizes complications.     

Disorders of vascularization in para-epiphyseal groove humeral fractures and their clinical significance for the growing skeleton

We analysed retrospectively 50 humerus fractures in the vicinity of elbow joint and 40 fractures of the proximal humerus with respect to possible injuries of the vessel pattern of the epiphyseal plate. The normal vessel pattern of the epiphyseal plate was examined postmortem on 8 foetus and newborns up to 6 months. We plastinated the affected regions and could compare symmetry of the vessel pattern in the epiphyseal plates as well as therapeutic consequences, especially after injuries of the elbow joint. Vascular disturbances in the case of young children, i.e. by fractures of the lateral oder medial condyle are undoubtedly seen. A fish-tail deformity can be a complication. By older children with mature epiphyseal plate we could not register any complications. In such cases we are interested in restoring the joint stability by refixation.     

An anatomic investigation of the elbow joint, with special reference to aging of the articular cartilage

The architecture of the articular surface of the elbow joint and the location of cartilage degeneration with aging was analyzed. The study included 131 elbow joints of 66 cadavers preserved by embalming. The age of subjects at death ranged from 49 to 96 years (mean 79 years). The elbow joint was observed macroscopically and analyzed. The degenerative changes in the radiohumeral joint were always more advanced than those in the humeroulnar joint. The erosion or chondral defect in the capitulum is located in the area 45° anterior to the long axis of the humerus. The anterior part of the erosion in the crest separating the trochlea from the capitulum was roughly 48.5° to the long axis of the humerus. It was similar in position to the erosion found in the capitulum. Based on the degree and area of cartilage degeneration, the changes in the radial head could be divided into four types. The mode of radial head cartilage degeneration correlated well with cartilage degeneration in the radiohumeral articulation and also with osteoarthritis of the elbow joint. Simplistically, one could classify elbow joint osteoarthritis by knowing the extent of radial head degeneration.     

Epiphyseal fractures

The distal humerus and distal tibia are the most common sites of epiphyseal fractures. Epiphyseal detachment was found to occur more often in the region of upper extremities. Treatment of children for epiphyseal fractures is inevitably accompanied by growth disorders. Articular and diaphyseal malpositions are controllable. Fractures in childhood and, consequently, epiphyseal fractures should be grouped by diaphyseal and articular fractures. Epiphyseal detachment should then be associated with diaphyseal fractures, and epiphyseal fractures should be grouped under articular fractures.