Résumé
Objective:To compare the effects of the fracture line direction in the sagittal profile on the Gartland type Ⅲ supracondylar humerus fractures in children.Methods:A total of 153 cases of Gartland type Ⅲ supracondylar humerus fractures treated in the Department of Pediatric Orthopedics, Qilu Hospital of Shandong University (Qingdao) from January 2017 to April 2019 were retrospectively analyzed.They were categorized into the traditional oblique type (the fracture line went downward in the front and upward in the back), transverse type (the fracture line went horizontally) and reverse oblique type (the fracture line went upward in the front and downward in the back). Gender, age, injury side, cause of injury, ecchymosis before elbow, preoperative neurological symptoms, operation time, incision ratio, and Flynn scores of the elbow joint at the last follow-up were compared among the 3 groups.Results:Patients were followed up for (8.65±2.47) months (6-15 months). There were 60, 64 and 29 patients in the traditional oblique type, transverse type and reserve oblique type groups, respectively.There were no differences in the gender, injury side, and injury causes among the 3 groups (all P>0.05). The age of the traditional oblique type, transverse type and reverse oblique type group were (4.76±2.51) years, (4.71±2.09) years and (6.32±1.98) years, respectively, which was significant different among the 3 groups ( F=5.826, P<0.05). There were 10, 7 and 11 cases of preoperative elbow ecchymosis occurred in children of the traditional oblique type, transverse type and reverse oblique type groups, respectively, which was significant different ( χ2=9.902, P<0.05). No significant differences were found in preoperative neurological symptoms of the 3 groups ( P>0.05). The operative time for the traditional oblique type, transverse type and reverse oblique type group were (43.28±24.25) min, (40.95±27.41) min and (58.66±34.08) min, which was significant different ( F=4.337, P<0.05). The traditional oblique type and transverse type groups had 1 failure case of closed reduction, respectively, and the incision was performed during the operation.There were 4 cases in the reverse oblique type group who underwent the open reduction.The reduction rate was significantly different among 3 groups ( χ2=6.883, P<0.05). There was no significant difference in the excellent to good rate of traditional oblique type (96.67%, 58/60 cases), transverse type(95.31%, 61/64 cases)and reserve oblique type (93.10%, 27/29 cases) among 3 groups ( P>0.05). Conclusions:The reverse oblique Gartland type Ⅲ supracondylar humerus fractures are relatively rare in clinical practice, which involves more severe soft tissue damages and more obvious antecubital ecchymosis.The conventional reduction methods seem to be ineffectual for the reverse oblique supracondylar humerus fractures.
Résumé
Objective To compare the clinical effects on Gartland type Ⅲ fractures in children by open reduction and external fixation with two parallel Kirschner wires and closed reduction.Methods From February 2013 to October 2016,84 children with Gartland type Ⅲ supracondylar fracture of humerus were selected and randomly divided into a control group and an observation group,each with a total of 42 cases.The control group received closed reduction treatment,and the observation group received open and external fixation with two parallel Kirschner wires.The two groups were compared on intraoperative blood loss,incision length,operating time,decreased degrees of carrying angle,reduced flexion-extension at the fractured side and the rates for good and excellent clinical effects.Results The observation group behaved significantly better than the control group in intraoperative blood loss,incision length and operating time (P＜0.05).The rates for good and excellent effects was 90.47％ in the observation group and 73.81％ in the control group,and there was obvious difference between the values in the two groups (P＜0.05).The observation group had the decreased degree of carrying angle statistically lower than that in the control group (P＜0.05),while the reduced flexion-extension at the fractured side was not significantly different from that in the control group (P＞0.05).Conclusion Open reduction and external fixation with two parallel Kirschner wires and closed reduction both gain their advantages when used to treat Gartland type llⅢ fractures in children,the former has high clinical effect,significantly recovered elbow joint function and low incidence rate for cubitus varus,and the latter has slight invasion,small incision while relatively low clinical effect and high incidence rate for cubitus varus.
Résumé
Objective To compare the clinical effects on Gartland type Ⅲ fractures in children by open reduction and external fixation with two parallel Kirschner wires and closed reduction.Methods From February 2013 to October 2016,84 children with Gartland type Ⅲ supracondylar fracture of humerus were selected and randomly divided into a control group and an observation group,each with a total of 42 cases.The control group received closed reduction treatment,and the observation group received open and external fixation with two parallel Kirschner wires.The two groups were compared on intraoperative blood loss,incision length,operating time,decreased degrees of carrying angle,reduced flexion-extension at the fractured side and the rates for good and excellent clinical effects.Results The observation group behaved significantly better than the control group in intraoperative blood loss,incision length and operating time (P＜0.05).The rates for good and excellent effects was 90.47％ in the observation group and 73.81％ in the control group,and there was obvious difference between the values in the two groups (P＜0.05).The observation group had the decreased degree of carrying angle statistically lower than that in the control group (P＜0.05),while the reduced flexion-extension at the fractured side was not significantly different from that in the control group (P＞0.05).Conclusion Open reduction and external fixation with two parallel Kirschner wires and closed reduction both gain their advantages when used to treat Gartland type llⅢ fractures in children,the former has high clinical effect,significantly recovered elbow joint function and low incidence rate for cubitus varus,and the latter has slight invasion,small incision while relatively low clinical effect and high incidence rate for cubitus varus.