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Suzanne Steinman Tracey P. Bastrom Peter O. Newton Scott J. Mubarak 《Journal of children's orthopaedics》2007,1(3):177-180
Purpose A recent study reported a higher incidence of pre-operative ulnar nerve symptoms in patients with flexion-type supracondylar
fractures than in those with the more common extension supracondylar fractures and a greater need for open reduction (Kocher
in POSNA paper #49 2006). We have encountered a specific pattern of flexion supracondylar fractures that often require open
reduction with internal fixation (ORIF) due to entrapment of the ulnar nerve within the fracture.
Methods Medical records and X-rays from 1997 to 2005 at our children’s hospital were examined to identify flexion supracondylar fractures
that required open reduction. The operative reports were reviewed to identify cases that had the ulnar nerve blocking the
reduction.
Results During the 8 years examined, 1,650 supracondylar fractures had been treated by means of closed reduction and percutaneous
pinning. Of these, only 1.8% or 30 cases could not be reduced closed and required open reduction internal fixation, excluding
11 open fractures. Of the 30 fractures requiring open reduction internal fixation, 24 were of the extension type needing ORIF
because of interposed periosteum/muscle. The other 6 patients had flexion-type supracondylar fractures that failed closed
reduction. All had a persistent medial gap at the fracture site. All 6 fractures had interposed periosteum or muscle, while
in 3 cases the ulnar nerve was also entrapped within the fracture site (Figs. 1, 2)
Conclusion Flexion-type supracondylar fractures remain a relatively uncommon variant (2–3%) of supracondylar fractures. Recent reports
have noted that open treatment of these fractures is required more frequently than for extension fractures. In our series,
20% of the open cases were flexion-type fractures and in half of these the ulnar nerve was found to be entrapped in the fracture,
preventing reduction.
Study conducted at Rady Children’s Hospital and Health Center. No financial support was received for this project. 相似文献
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Frances A. Farley Prerana Patel Clifford L. Craig Laurel C. Blakemore Robert N. Hensinger Lingling Zhang Michelle S. Caird 《Journal of children's orthopaedics》2008,2(2):91-95
Purpose Outcomes in children with supracondylar humerus fractures were stratified by type of treating orthopedic surgeon: pediatric
orthopedic surgeon and nonpediatric orthopedic surgeon.
Methods The outcome factors in 444 children examined included: open reduction rate, complications, postoperative nerve injury, repinning
rate, need for physical therapy, and residual nerve palsy at final follow-up.
Results For the severe fractures, significantly more fractures were treated by open reduction in the pediatric orthopedic surgeon
group than in the nonpediatric orthopedic surgeon group. There were no other significant differences in outcomes between the
fractures treated by the pediatric orthopedic surgeons and nonpediatric orthopedic surgeons.
Conclusions This study supports the assertion that both pediatric and nonpediatric orthopedic surgeons in an academic setting have sufficient
training, skill, and experience to treat these common injuries.
Study presented at the Trauma Session of the Pediatric Orthopedic Society of North America Annual Meeting, San Diego, CA,
May 2006. 相似文献
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Korompilias AV Lykissas MG Mitsionis GI Kontogeorgakos VA Manoudis G Beris AE 《International orthopaedics》2009,33(1):237-241
Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures,
the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with
displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise
well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction
and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy
was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery
contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial
artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction.
Résumé Au cours d’une fracture supra condylienne du coude déplacée, les complications vasculaires sont relativement fréquentes. Le traitement, lui aussi, est largement controversé, notamment lorsqu’il existe une absence de pouls radial après la fracture. Entre 1994 et 2006, 66 enfants présentant une fracture supra condylienne du coude ont été traités. 5 présentaient une complication vasculaire avec absence de pouls radial. Chez un des patients, le pouls radial est réapparu après réduction à foyer fermé. Chez les 4 autres patients, il a été nécessaire de faire une réduction sanglante avec exploration vasculaire. 3 des patients avaient une occlusion de l’artère humérale. La thrombectomie a été réalisée avec restauration du pouls radial. Sur un patient, il s’agissait d’une contusion de l’artère brachiale avec spasme et une réapparition du pouls après endar térectomie. L’exploration vasculaire chirurgicale doit être réalisée même si la main se recolore après une réduction à foyer fermé.相似文献
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Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury
Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative
complications have been documented in the literature. Neurovascular injury due to fracture fragments
following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques. 相似文献
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膝关节镜下股骨髁上交锁髓内钉治疗股骨髁上骨折 总被引:5,自引:0,他引:5
目的 评价膝关节镜下股骨髁上交锁髓内钉 (简称GSH钉 )固定股骨髁上骨折的效果。 方法 行小切口开放复位后在关节镜监视下经皮逆行击入GSH钉固定治疗 16例股骨髁上骨折。 结果 所有骨折均在 3月内达骨性愈合 ,随访6月~ 18月 ,膝关节屈曲均达 110°以上。 结论 膝关节镜下GSH钉固定股骨髁上骨折不需切开膝关节 ,不需外固定 ,对关节功能影响小 ,是治疗股骨髁上骨折的一种损伤小、固定可靠、恢复快的新方法。 相似文献
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Joseph M. Queally Natasha Paramanathan James C. Walsh Cathal J. Moran Fintan J. Shannon Lester G. D'Souza 《Injury》2010,41(6):568-571
Introduction
The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.Methods
We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period. The primary end points were a major loss of reduction as determined by radiological alignment and iatrogenic ulnar nerve injury. Secondary end points included clinical alignment, elbow range of motion and complications.Results
A total of 43 patients, who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type II and type III) of the humerus were reviewed with a mean follow-up time of 36 months. No major loss of reduction occurred. The mean change in Baumann's angle (4.2 ± 1.6°) between intra-operative and follow-up radiographs was not significant (p > 0.05). No iatrogenic case of ulnar nerve injury occurred. The ‘carrying angle’ and ‘return to function’ in all children had returned to normal relative to the other side. Postoperative complications consisted of three patients developing pin-site infections, which were successfully treated.Conclusion
Dorgan's lateral cross-wiring technique is an effective option in treating displaced supracondylar fractures of the humerus in children. It is as effective as the traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve injury. 相似文献9.
自1998-2002年我院行肘外侧切口切开复位克氏针内固定治疗肱骨髁上骨折。术后出现10例肘内翻畸形,现将经验教训报告如下。1 临床资料1.1 一般资料 10例中男7例,女3例;年龄4~11岁,髁上骨折4例,低位髁上骨折6例,均为闭合性伸直型肱骨髁上骨折,行肘外侧切口复位内固定,术后10例均不同程度出现尺偏肘内翻畸形,其中1例并发尺神经症状。1.2 治疗方法及结果 本组8例术后拍片发现肘关节尺偏畸形行再次整复手术,修整桡侧骨皮质后畸形矫正,1例合并尺神经症状经局部理疗及神经营养治疗后神经症状消失;2例1年复查时发现行髁上 相似文献
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肱骨髁上骨折治疗的疑难及对策 总被引:1,自引:0,他引:1
少儿常见的肱骨髁上骨折治疗最难点是极易发生肘内翻畸形。本文总结了1988年以来治疗的112例,其中伸直尺偏型87例,治疗结果按李稔生等评定标准,优49例,良43例,差20例,肘内翻率较高。本文即从旋转移位、尺倾尺偏和固定这3方面分析了肘内翻的成因,并提出了相应的对策,即从辨清远折端旋转方向并纠正之、彻底纠正尺偏尺倾移位和正确固定复位后的患肢3方面入手,可明确降低肘内翻的发生率。 相似文献
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两种克氏针固定方法治疗儿童肱骨髁上骨折疗效比较 总被引:1,自引:1,他引:0
目的:探讨两种克氏针固定方法治疗儿童肱骨髁上骨折的疗效。方法:自2004年1月至2006年12月应用克氏针内固定治疗儿童肱骨髁上骨折117例,按克氏针固定方式分组:两针组45例,男31例,女14例;年龄1~11岁,平均5.6岁;Garland Ⅱ型19例,Ⅲ型26例。三针组72例,男47例,女25例;年龄2~12岁,平均6.8岁;Garland Ⅱ型22例,Ⅲ型50例。术后测量肘关节屈伸范围及提携角,参照Flynn肱骨髁上骨折疗效评定标准及术后并发症情况,分析两种克氏针内固定方式的疗效。结果:所有患儿均获随访,时间2~24个月,平均15.4个月。两针组45例:优27例,良12例,可4例,差2例,41例术后6周均获得骨性愈合,4例术后1周骨折端移位,固定失败,肘内翻畸形2例。三针组72例:优60例,良11例,差1例,所有患儿术后6周均获得骨性愈合,屈伸活动度经功能锻炼后基本恢复正常,肘内翻畸形1例。结论:克氏针固定是一种稳定而可靠的治疗儿童肱骨髁上骨折方法,内外髁三针交叉固定较单纯外髁两针固定有更大的优点。 相似文献
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目的探讨儿童肱骨髁上骨折的治疗效果。方法我科自1995年3月至2005年3月对153例肱骨髁上骨折患儿应用手法复位、牵引、小夹板或石膏托固定、手术治疗,随访0.5~5年。结果失访4例,优142例,占95.3%,良7例,占4.7%,愈合时间平均4.5周。结论手法复位、尺骨鹰嘴骨牵引后复位并小夹板或石膏托超肘关节外固定是治疗小儿肱骨髁上骨折较好的方法。 相似文献
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张希全|葛世堂|陈众|窦树彬|董戈|郭锋 《中国普通外科杂志》2017,26(6):764-769
目的:探讨自膨式金属裸支架治疗急性肱动脉损伤的安全性及临床效果。方法:回顾性分析18例急性肱动脉损伤患者资料。所有患者均接受急诊血管造影以明确诊断,行血管成形术及自膨式裸支架植入治疗。结果:18例急性肱动脉损伤的患者的手术技术成功率100%,平均手术时间为50(30~90)min。13例接受单层自膨式裸支架置入,5例接受双支架重叠置入术,共置入23枚自膨式裸支架,支架置入后即刻造影显示损伤肱动脉血流恢复通畅,假性动脉瘤消失,未见支架狭窄及对比剂外溢。无围手术期死亡和严重并发症发生。18例平均随访20.2个月,17例支架内血流完全通畅或轻度狭窄(未作处理),1例支架腔内狭窄50%,行球囊扩张治疗后支架内血流恢复通畅;随访期间无支架移位、扭曲及断裂,无缺血坏死,截肢情况。结论:自膨式金属裸支架植入治疗急性肱动脉损伤是安全可行的,近中期效果满意。 相似文献
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目的:评价腘动脉压迫综合征手术治疗的长期效果,总结治疗经验。
方法:回顾性分析北京大学人民医院血管外科2002年7月—2009年3月收治的6例腘动脉压迫综合征的临床及随访资料。
结果:6例患者中,男5例,女1例;年龄16~56岁,平均28岁;腘动脉闭塞4例,腘动脉狭窄合并动脉瘤形成2例;后入路S型切口行解剖异常的肌束切断术和血管重建3例(1例部分动脉瘤瘤壁切除缩缝成形,1例部分动脉瘤瘤壁切除+大隐静脉补片成形,1例腘动脉内膜剥脱术),未进行腘窝探查,行内侧入路行自体大隐静脉旁路手术3例。随访64~144个月,平均110.8个月,6例患肢术后症状均好转,无神经损伤、坏疽等并发症;5例患肢随访中间歇性跛行症状无复发,原位/旁路动脉通畅,1例术后分别在49、51个月因间歇性跛行就诊,发现旁路大隐静脉闭塞,导管溶栓开通后再闭塞,目前保守治疗。1、5年的1期通畅率分别为100.0%(6/6)、83.0%(5/6)。
结论:手术是治疗腘动脉压迫综合征的有效方式,术后长通畅率满意。若条件允许应优先考虑后入路腘动脉原位重建。 相似文献
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S. Yildirim T. Zafer Nursal T. Yildirim A. Tarim K. Caliskan 《Acta chirurgica Belgica》2013,113(2):190-193
Haemodialysis patients carry a high risk of pseudoaneurysm due to inadvertent puncture of the brachial artery during venous cannulation for haemodialysis.Signs and symptoms are pulsatile mass and a systolic murmur. Complications are rupture, infection, haemorrhage, distal arterial insufficiency, venous thrombosis and neuropathy. Early diagnosis is essential to plan adequate treatment. Doppler US and angiography usually confirm the lesion accurately. Ultrasound guided compression, percutaneous injection of thrombin, endovascular covered stent exclusion, aneurysmectomy and surgical repair are different treatment options.We report clinical and radiological findings and treatment strategies in four dialysed patients who developed brachial artery pseudoaneurysms. 相似文献
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L. V. Barr 《Journal of children's orthopaedics》2014,8(2):167-170
Purpose
The purpose of this study was to investigate the epidemiology of paediatric patients sustaining supracondylar humeral fractures, to identify common mechanisms of injury and to corroborate the anecdotal evidence that fractures occur more frequently during school holidays.Methods
All paediatric patients who presented to the accident and emergency department with a supracondylar distal humerus fracture over the 3-year period from 1 July 2008 to 30 June 2011 were included in the study. Data were collected from the electronic medical records and radiology picture archiving and communication system (PACS) regarding age at injury, sex, Gartland type, date of injury, mechanism and management. The dates of all school holidays during the study period were obtained from the local education authority website.Results
A total of 159 patients were identified, with a median age of 6 years 1 month (range 1 year to 14 years 4 months); 53 % of patients were male. The 155 extension-type injuries comprised 46, 28 and 26 % Gartland I, II and III fractures, respectively. Sixty-five patients (41 %) were treated operatively. Six patients had either neurological and/or vascular complications; however, none had any long-term neurological compromise and none required vascular surgical intervention. The mechanism of injury was recorded in 118 cases, the majority (37 %) of which were sustained during falls from play equipment. Among the patients, 115 were of school age. The weekly incidence during school holidays was significantly higher than that during term-time (1.16 vs. 0.60, p = 0.0005).Conclusions
This study demonstrates the epidemiology of paediatric supracondylar fractures managed at a district general hospital over a 3-year-period. This work supports the long-standing anecdotal evidence that play equipment carries a high risk of injury and that the incidence of supracondylar fractures is significantly higher during school holidays. 相似文献18.
This retrospective study evaluated different pinning configurations used in the treatment of displaced supracondylar humeral fractures among children, mainly regarding maintenance of fracture reduction and avoidance of complications. The fractures (41 type II and 67 type III) of 108 children (mean age 6.48 years) were treated by closed reduction and percutaneous pinning: 37 with crossed pins, 37 with two lateral pins and 34 with two lateral and one medial pin. Mean follow-up period was 7.4 months. Type III fractures fixed by two lateral pins were found significantly prone to postoperative instability, late complications and need for medial pin fixation. There was a significant relation between either delay to surgery or postoperative instability and occurrence of complications. Final outcome was significantly poorer in type III than in type II fractures. Fixation by two lateral pins only is not recommended for treating type III supracondylar humeral fractures, but could be used initially to fix severely unstable fractures to allow extension of the elbow before inserting a medial pin. Every effort should be made to avoid iatrogenic ulnar nerve injury while inserting the medial pin. 相似文献
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薄层连续MRI扫描描记臂丛神经 总被引:3,自引:0,他引:3
目的 通过薄层连续MRI扫描显示臂丛神经形态。方法 采用1.5-T MRI(GE,Signa)对6例健康志愿者行双侧臂丛神经斜矢状位和冠状位扫描,确认其与周围组织解剖定位关系,并观察其走行和分支情况。结果 所有志愿者的臂丛神经均得到了较好的显示,斜矢状位T2加权压脂可明显显示臂丛神经及部分神经束,特别是神经根出口处可以得到很好的显示。结论 薄层连续MRI扫描可以显示臂丛神经的形态,可以提高其对臂丛损伤的诊断。 相似文献