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Title: [Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children].
Author: Ma H, Liu F, Zhou Z, Zhang S, Hua Z, Jia G, Sun J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Oct 15; 37(10):1220-1224. PubMed ID: 37848316.
Abstract:
OBJECTIVE: To investigate the effectiveness of medial and lateral column periosteal hinge reconstruction using Kirschner wire in the closed reduction of multi-directional unstable humeral supracondylar fractures in children. METHODS: A clinical data of 43 children with multi-direction unstable humeral supracondylar fractures, who met the selection criteria and were admitted between August 2020 and August 2022, was retrospectively analyzed. Twenty-one cases of fractures were treated wuth closed reduction after medial and lateral column periosteal hinge reconstruction using Kirschner wire and percutaneous Kirschner wires fixation (study group), while 22 cases of fractures were treated by traditional closed reduction technique and percutaneous Kirschner wire fixation (control group). There was no significant difference in gender, age, cause of injury, fracture side, and interval from injury to operation between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, the number of children who were changed to open reduction after closed reduction failure, fracture healing time, complications within 2 months after operation, and the Flynn score of elbow joint function at last follow-up were compared between the two groups. RESULTS: All the fractures in the study group were successfully closed reduction, and 4 cases in the control group were changed to open reduction and completed the operation, the difference between the two groups was significant ( P=0.040). The operation time and intraoperative fluoroscopy times of the study group were significantly less than those of the control group ( P<0.05). All children in both groups were followed up 6-18 months with an average of 9.0 months in the study group and 9.8 months in the control group. Imaging review showed that the fractures of both groups healed, and the difference in the healing time between the two groups was not significant ( P=0.373). According to Flynn score at last follow-up, the excellent and good rate of elbow joint function was 95.2% (20/21) in the study group and 86.4% (19/22) in the control group, with no significant difference ( P=0.317). There was no complication such as infection or irritation at the end of Kirchner wire within 2 months after operation. CONCLUSION: For children with multi-directional unstable humeral supracondylar fractures, the use of Kirschner wires to reconstruct the medial and lateral column periosteal hinge to assist in closed reduction has the advantages of shortening operation time, reducing intraoperative fluoroscopy times, and effectively reducing the incidence of open reduction, and can achieve similar postoperative elbow joint function when compared with traditional closed reduction technique. 目的: 探讨克氏针重建内、外侧柱骨膜铰链辅助儿童多方向不稳定肱骨髁上骨折闭合复位的效果。. 方法: 回顾分析2020年8月—2022年8月收治且符合选择标准的43例儿童多方向不稳定肱骨髁上骨折临床资料。其中，21例采用克氏针重建内、外侧柱骨膜铰链辅助闭合复位后经皮克氏针内固定治疗（研究组），22例采用传统闭合复位经皮克氏针内固定治疗（对照组）。两组患儿性别、年龄、致伤原因、骨折侧别以及受伤至手术时间等基线资料比较，差异均无统计学意义（ P>0.05）。比较两组手术时间、术中透视次数、闭合复位失败改行切开复位例数、骨折愈合时间、术后2个月内并发症发生情况以及末次随访时肘关节功能Flynn评分。. 结果: 研究组骨折均闭合复位成功，对照组4例改为切开复位后完成手术，两组差异有统计学意义（ P=0.040）。研究组手术时间、术中透视次数均少于对照组，差异有统计学意义（ P<0.05）。两组患者均获随访，随访时间6～18个月，研究组平均9.0个月、对照组平均9.8个月。影像学复查示两组骨折均愈合，愈合时间差异无统计学意义（ P=0.373）。末次随访时根据Flynn评分标准，研究组肘关节功能优良率为95.2%（20/21）、对照组为86.4%（19/22），差异无统计学意义（ P=0.317）。术后2个月内均无感染、克氏针针尾激惹等并发症发生。. 结论: 对于儿童多方向不稳定肱骨髁上骨折，克氏针重建内、外侧骨膜铰链辅助闭合复位与传统闭合复位技术相比，具有缩短手术时间、减少术中透视次数以及有效避免切开复位的优势，且能获得相似的术后肘关节功能。.

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