Sun Qiang,Ye Jiajun.Clinical study of three-dimensional rotary reduction and modified rotary reduction with needle for extended ulnar deviated supracondylar humeral fractures in children with Gartland type Ⅲ/Ⅳ[J].Journal of Clinical Pediatric Surgery,,21():637-642.[doi:10.3760/cma.j.cn101785-202106037-008]
Clinical study of three-dimensional rotary reduction and modified rotary reduction with needle for extended ulnar deviated supracondylar humeral fractures in children with Gartland type Ⅲ/Ⅳ
- Keywords:
- Bones and Tissues; Humeral Fractures; Reducting Luxation; Closed Fracture Reduction; Fracture Fixation; Internal
- Abstract:
- Objective To evaluate the clinical efficacy of three-dimensional rotary reduction versus modified rotary reduction with needle for children with extended ulnar deviation supracondylar humeral fractures in Gartland Ⅲ/Ⅳ. Methods From March 2019 to March 2020, 130 children with extended ulnar supracondylar humeral fracture were recruited.There were 67 boys and 63 girls with an age range of (5.8±2.9) years.The involved side was left (n=62) and right (n=68).There were straight ruler with outward rotation (n=106) and straight ruler with inward rotation (n=24).Time from injury to operation ranged from 2h to 3d and emergency operation (n=20) was performed.Fracture types were Gartland Ⅲ (n=64) and Gartland Ⅳ (n=66).According to different methods of fracture repair, order and method of placing Kirschner wire, they were divided into two groups of three dimensional rotary reduction (n=65) and improved rotary reduction with needle (n=65).Baumamn Angle of injured extremity was measured by digital imaging examination system and postoperative ROM (range of motion) degree of elbow, postoperative Baumamn angle change, loss angle and Flynn’s elbow function were evaluated.Results All fractures healed during follow-ups.Statistically significant inter-group difference existed in operative duration (P<0.05).However, no statistically significant difference existed in follow-up time, fracture healing time, cubitus varus deformity or Kirschner wire loosening (P>0.05).And statistically significant inter-group difference existed in postoperative needle infection (P<0.01).At Month 3 post-operation, ROM of injured elbow was compared and the inter-group difference was statistically significant (P<0.05).No significant inter-group difference existed in Baumamn angle immediately after extremity injury (P>0.05).No inter-group significant difference existed in Baumamn angle loss at Month 12 after extremity injury (the last follow-up) (P>0.05).At Month 12 post-operation, Flynn’s elbow function was compared and the inter-group difference was statistically significant (P<0.05).There was no onset of compartment syndrome, Kirschner wire rupture/rejection, iatrogenic vascular nerve injury, Volkmann’s contracture or myositis ossificans. Conclusion As compared with three-dimensional rotary reduction, for Gartland Ⅲ/Ⅳ children with straight ulnar partial humeral supracondylar fracture, modified rotary reduction offers the advantages of shorter operative duration, better recovery of elbow flexion/extension and appearance of lifting angle.A wider popularization is worthwhile.
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收稿日期:2021-06-14。
基金项目:四川省中医药管理局基金课题（2020LC0181）
通讯作者:孙强,Email:2357401669@qq.com