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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children
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Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children

机译：保留肱三头肌的方法可对儿童被忽视的displaced上displaced上和肱骨远端骨折进行切开复位和内固定

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class="Heading">Background class="Para">Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20?% of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14?days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children. class="Heading">Materials and methods class="Para">This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49?months, with a mean period of 17?months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria. class="Heading">Results class="Para">All fractures united in a mean duration of 7.2?weeks (range 5–10?weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66?%), while good results were found in two patients (13.33?%) according to the MEPI scale. According to the Mark functional criteria, there was one patient with a fair result (6.66?%). class="Heading">Conclusion class="Para">The results were very satisfactory if compared with traditional operative techniques, with many advantages including anatomical reduction and fixation of the fractures, avoidance of ulnar nerve injury, preservation of the extensor mechanism, decrease in incidence of myositis ossificans around the elbow and decrease in post-operative stiffness. class="Heading">Level of evidence class="Para">IV.
机译：class =“ Heading”>背景 class =“ Para”> con上肱骨骨折是儿童中最常见的骨骼损伤之一。在移位和不稳定的情况下，标准手术是早期闭合复位和经皮克氏针固定。但是，有10％至20％的患者迟到。根据文献，骨折被忽视的患者是那些在受伤14天后就诊的患者。延误是由于缺乏医疗设施或社会和财政限制。被忽视的病例通常是闭合性损伤，无血管受损。但是，肘部仍可能因擦伤或结rust而变得紧张和肿胀。在被忽视的情况下，尤其是在愈伤组织早期出现后，就没有闭合复位和经皮固定的地方。传统上，由于肱三头肌无力和肘部僵硬，肱骨远端骨折已通过外科手术方法进行了治疗，这些手术方法破坏了伸肌机制，但功能预后较差。这项研究的目的是评估使用肱三头肌保留方法和克氏针固定术治疗儿童被忽视，移位的con上和肱骨远端骨折延迟开放复位的效果。 class =“ Heading”>材料和方法 class =“ Para”>这项前瞻性研究纳入了15名忽略了displaced上移位和肱骨远端骨折的儿童。干预之前，手术后和随访期间，所有患者均经过临床和放射学全面评估。随访时间为8到49个月，平均17个月。功能结局根据Mayo肘关节性能指数（MEPI）和Mark功能标准进行评估。 class =“ Heading”>结果 class =“ Para”>所有骨折均以均值合并持续时间为7.2周（5-10周），无继发性移位或畸形愈合。在最后一次随访中，根据MEPI量表，在研究的15位患者中有13位（86.66％）获得了出色的结果，而在2位患者（13.33 %%）上得到了良好的结果。根据Mark的功能标准，有1例患者的结果令人满意（6.66％）。 class =“ Heading”>结论 class =“ Para”>结果非常好如果与传统手术技术相比，则令人满意，具有许多优势，包括解剖上减少和固定骨折，避免尺神经损伤，保留伸肌机制，减少肘周围骨化性肌炎的发生率以及术后僵硬度的降低。 / p> class =“ Heading”>证据级别 class =“ Para”> IV。

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