ABSTRACT
Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)
Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Closed Fracture Reduction , Fractures, Closed , Humeral Fractures, Distal , PainABSTRACT
Objective To compare the clinical effect between olecranon osteotomy and bilateral triceps brachii approach combined with bilateral locking plate in the treatment of type C3 distal humerus fracture.Methods Forty-five patients with type C3 distal humerus fracture were performed with operation and follow-up in Department of Osteology of the First People's Hospital of Xinxiang City from July 2006 to February 2016.The patients were divided into olecranon osteotomy group (n =25) and bilateral triceps brachii approach group (n =20).The patients in olecranon osteotomy group were treated with olecranon osteotomy combined with bilateral locking plate,and the patients in bilateral triceps brachii approach group were treated with bilateral triceps brachii approach combined with bilateral locking plate.The incision length,operation time,hospitalization time,fracture healing time,postoperative complications and the score of elbow joint function were compared between the two groups.Results There was no significant difference in the mean follow-up time between the two groups (P ＞ 0.05).The incision length in olecranon osteotomy group was significantly shorter than that in bilateral triceps brachii approach group(P ＜ 0.05).There was no significant difference in the operation time,hospitalization time and fracture healing time between the two groups (P ＞ 0.05).There was one case of infection and two cases of heterotopic ossification in the olecranon osteotomy group,and the incidence of postoperative complications was 12.0％ (3/25).There was one case of heterotopic ossification,one case of fracture delayed union and one case of elbow joint stiffness in the bilateral triceps brachii approach group,and the incidence of postoperative complications was 15.0％ (3/20).There was no significant difference in the incidence of postoperative complications between the two groups (x2 =0.087,P ＞ 0.05).At the end of the follow-up,the excellent rate of the Mayo score of elbow joint function in the olecranon osteotomy group and bilateral triceps brachii approach group was 88.0％ (22/25) and 55.0％ (11/20) respectively,the excellent rate in the olecranon osteotomy group was significantly higher than that in the bilateral triceps brachii approach group (x2 =6.188,P ＜ 0.05).Conclusion Compared with the bilateral triceps brachii approach,the olecranon osteotomy combined with bilateral locking plate fixation is more beneficial to the recovery of elbow joint function in patients with type C3 distal humerus fracture.
ABSTRACT
Objective To compare the curative effects of three fixed methods in the management of distal humeral fractures in adults.Methods From January 2012 to December 2015,120 adults patients with distal humeral fractures admitted to our hospital were enrolled in this prospectively study.According to the principle of random digital table,all patients were randomly signed into single plate fixation group,Y type plate fixation group or double plates fixation group.The primary outcomes included surgical approach,elbow function recovery and postoperative complica-tions.Results Significantly differences were observed among the three groups in fracture union time[(99.48 ± 11.81)d vs.(108.93 ±11.05)d vs.(111.35 ±11.11)d,F =12.274,P =0.000)];there was no difference in fracture union time between the single plate fixation group and Y type plate fixation group (t =0.979,P =0.331). However,patients in double plates fixation group got a significantly shorter fracture union time when compared with the single plate fixation group or Y type plate fixation group (t =3.696,4.632,both P =0.000).Significantly differences were observed among the three groups in Mayo elbow performance score three months after the operation[(88.63 ±7.35)points vs.(79.98 ±6.06)points vs.(79.60 ±6.5)points,F =12.274,P =0.000)].There was no difference in Mayo elbow performance score between the single plate fixation group and Y type plate fixation group (t =0.266, P =0.791).However,the patients in the double plates fixation group got a significantly higher Mayo elbow perform-ance score (t =5.742,5.799,both P =0.000).There was no difference among the three groups in operation duration,intraoperative bleeding volume,failure rate of internal fixation,surgical site infection,ulnar neuritis,myositis ossificans and loosening of the plate (all P >0.05).Conclusion Double plates is more in line with the biomechanical characteristics of the distal humerus,and it is beneficial to the functional recovery of elbow joint.