Sun Liang,Cui Xiaolong,Liu Wanlin,et al.Clinical results of ultra-early plaster removal after percutaneous needle fixation for supracondylar humeral fractures in children[J].Journal of Clinical Pediatric Surgery,,22():982-987.[doi:10.3760/cma.j.cn101785-202103020-015]
Clinical results of ultra-early plaster removal after percutaneous needle fixation for supracondylar humeral fractures in children
- Keywords:
- Supracondylar Humeral Fracture; Closed Fracture Reduction; Fracture Fixation; Internal; Casts; Surgical; Treatment Outcome; Comparative Study
- Abstract:
- Objective To explore the clinical safety and efficacy of ultra-early removal of external plaster fixation (2 weeks post-operation) after percutaneous needle fixation for supracondylar humeral fracture in children.Methods A prospective analysis was conducted for 100 Gartland Ⅱ/Ⅲ children with extended supracondylar humeral fractures from January 2018 to December 2020.A total of 88 children fulfilled the inclusion criteria,including 52 boys and 33 girls.All of them underwent closed reduction and percutaneous internal fixation.They were randomized into two groups of observation (n=43) and control (n=45).In observation group,plaster external fixation was removed at Week 2 and Kirschner wire at Week 4 post-operation.In control group,plaster external fixation was removed at Week 4 post-operation and Kirschner wire at Week 6-8 post-operation.Both groups received radiograph examination immediately and at Week 12 post-operation.Clinical assessments included Baumann,carrying and capitellohumeral angles immediately and at Week 12 post-operation.Range of motion of affected elbow was assessed at Week 6/12 (versus healthy side).The good/excellent rate of elbow function was assessed by the Flynn score at the last follow-up.T,Chi-square and Fisher’s exact tests were employed for comparing Baumann angle,carrying angle,capitellohumeral angle,range of motion of elbow and Flynn score to evaluate the outcomes of elbow function,the occurrence of postoperative compartment syndrome and infection rate.The postoperative follow-up period was at least 12 weeks.Results All fractures reached clinical healing standards at Week 4-8 post-operation.At Week 6 post-operation,mean mobility limit of elbow joint was (3.09±1.38)°in observation group and (15.91±3.26)°in control group and the difference was statistically significant (P<0.05).At Week 12 post-operation,mean limit of elbow movement was <5°in both groups.Observation group was (0.95±0.95)?nd control group (1.02±0.87)°without statistical significance (P＞0.05).No significant inter-group differences existed in Baumann,carrying and capitellohumeral angles of affected elbow immediately after surgery and at Week 12 post-operation (P＞0.05).No reduction angle was lost in observation group due to ultra-early plaster removal.According to Flynn score at the last follow-up,good/excellent rates of elbow joint function were similar between two groups without statistical significance (P＞0.05).There was no compartment syndrome in neither groups.There was no needle infection in observation group while 4 cases of needle infection in control group were cured by oral antibiotics after removing Kirschner wire.Conclusion After percutaneous needle internal fixation for Gartland Ⅱ/Ⅲ supracondylar humeral fractures in children,ultra-early removal of cast (2 weeks post-operation) will not lead to a loss of reduction angle or increase the risk of reoperation.Elbow function of affected side basically normalizes at Week 6 post-operation and recovery time of elbow becomes significantly shortened.The incidence of needle tract infection is low.However,the sample size of this study is too small.Its clinical safety and efficacy should be confirmed by a larger randomized controlled trial.
References:
[1] Otsuka NY,Kasser JR.Supracondylar fractures of the humerus in children[J].J Am Acad Orthop Surg,1997,5(1):19-26.DOI:10.5435/00124635-199701000-00003.
[2] Vaquero-Picado A,González-Morán G,Moraleda L.Management of supracondylar fractures of the humerus in children[J].EFORT Open Rev,2018,3(10):526-540.DOI:10.1302/2058-5241.3.170049.
[3] Gartland JJ.Management of supracondylar fractures of the humerus in children[J].Surg Gynecol Obstet,1959,109(2):145-154.
[4] Lee YH,Lee SK,Kim BS,et al.Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children[J].J Pediatr Orthop,2008,28(4):417-422.DOI:10.1097/BPO.0b013e318173e13d.
[5] Skaggs DL,Cluck MW,Mostofi A,et al.Lateral-entry pin fixation in the management of supracondylar fractures in children[J].J Bone Joint Surg Am,2004,86(4):702-707.DOI:10.2106/00004623-200404000-00006.
[6] Mazda K,Boggione C,Fitoussi F,et al.Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children.A prospective study of 116 consecutive patients[J].J Bone Joint Surg Br,2001,83(6):888-893.DOI:10.1302/0301-620x.83b6.11544.
[7] Shim JS,Lee YS.Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires[J].J Pediatr Orthop,2002,22(1):12-16.
[8] Pirone AM,Graham HK,Krajbich JI.Management of displaced extension-type supracondylar fractures of the humerus in children[J].J Bone Joint Surg Am,1988,70(5):641-650.
[9] Popowics TE,Rensberger JM,Herring SW.Enamel microstructure and microstrain in the fracture of human and pig molar cusps[J].Arch Oral Biol,2004,49(8):595-605.DOI:10.1016/j.archoralbio.2004.01.016.
[10] Garg S,Weller A,Larson AN,et al.Clinical characteristics of severe supracondylar humerus fractures in children[J].J Pediatr Orthop,2014,34(1):34-39.DOI:10.1097/BPO.0b013e31829c0046.
[11] Flynn JC,Matthews JG,Benoit RL.Blind pinning of displaced supracondylar fractures of the humerus in children.Sixteen years’ experience with long-term follow-up[J].J Bone Joint Surg Am,1974,56(2):263-272.
[12] Camp J,Ishizue K,Gomez M,et al.Alteration of Baumann’s angle by humeral position:implications for treatment of supracondylar humerus fractures[J].J Pediatr Orthop,1993,13(4):521-525.DOI:10.1097/01241398-199307000-00019.
[13] 倪宏强,楼跃.儿童肱骨髁上骨折的治疗进展[J].临床小儿外科杂志,2020,19(4):364-369,376.DOI:10.3969/j.issn.1671-6353.2020.04.016.Ni HQ,Lou Y.Therapeutic advances of supracondylar humeral fractures in children[J].J Clin Ped Sur,2020,19(4):364-369,376.DOI:10.3969/j.issn.1671-6353.2020.04.016.
[14] Lucas DE,Willis LM,Klingele KE.Factors predictive of early radiographic failure after closed reduction of Gartland type II supracondylar humeral fractures[J].J Orthop Trauma,2013,27(8):457-461.DOI:10.1097/BOT.0b013e31827aa78e.
[15] Kocher MS,Kasser JR,Waters PM,et al.Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children.A randomized clinical trial[J].J Bone Joint Surg Am,2007,89(4):706-712.DOI:10.2106/JBJS.F.00379.
[16] Na YY,Bai R,Zhao ZQ,et al.Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures:a meta-analysis[J].J Orthop Surg Res,2018,13(1):68.DOI:10.1186/s13018-018-0768-3.
[17] Jandri? S.Effects of physical therapy in the treatment of the posttraumatic elbow contractures in the children[J].Bosn J Basic Med Sci,2007,7(1):29-32.DOI:10.17305/bjbms.2007.3085.
[18] Colovi? H,Stankovi? I,Dimitrijevi? L,et al.The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children[J].Vojnosanit Pregl,2008,65(1):27-32.DOI:10.2298/vsp0801027c.
[19] Keppler P,Salem K,Schwarting B,et al.The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children[J].J Pediatr Orthop,2005,25(3):314-316.DOI:10.1097/01.bpo.0000153879.05314.d8.
[20] He M,Wang Q,Zhao JX,et al.Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents[J].J Orthop Surg Res,2021,16(1):520.DOI:10.1186/s13018-021-02671-4.
[21] Azzolin L,Angelliaume A,Harper L,et al.Optimal postoperative immobilisation for supracondylar humeral fractures[J].Orthop Traumatol Surg Res,2018,104(5):645-649.DOI:10.1016/j.otsr.2018.03.015.
Memo
收稿日期:2021-3-11。
通讯作者:白锐,Email:bairuiandaiqing@126.com