Arthroscopic assisted reduction versus open reduction in treatment of paediatric humeral lateral condylar fractures with Kirschner wire fixation
10.3760/cma.j.cn115530-20240124-00043
- VernacularTitle:关节镜辅助复位与切开复位克氏针固定治疗儿童肱骨外髁骨折的疗效比较
- Author:
Lin HUANG
1
;
Chao FENG
;
Gang FU
;
Guisen YAN
;
Zheng YANG
;
Xuemin LYU
Author Information
1. 首都医科大学附属北京积水潭医院小儿骨科，北京 100035
- Keywords:
Arthroscopy;
Elbow;
Humerus fracture;
Minimal invasive, surgery
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(5):378-384
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy between arthroscopically assisted reduction versus open reduction in the treatment of paediatric humeral lateral condylar fractures with Kirschner wire fixation.Methods:A retrospective study was conducted to analyze the data of 28 children with humeral lateral condylar fracture who had undergone surgery at Department of Pediatric Orthopedics, Beijing Jishuitan Hospital from August 2023 to September 2023. There were 24 males and 4 females with an age of (6.5±1.6) years, 24 cases of type Ⅱ and 4 cases of type Ⅲ fractures according to the Jacob classification, and 1 case of type Ⅰ and 27 cases of type Ⅱ fractures according to the Milch classification. The time from injury to surgery averaged (71.6±21.3) hours. The children were divided into 2 groups according to their reduction methods: an arthroscopic group of 16 cases treated by arthroscopically assisted reduction and K-wire fixation and an open reduction group of 12 cases treated by open reduction and K-wire fixation. The operation time, incision length, Kirschner wire removal time, Mayo elbow performance score (MEPS) and the incidence of lateral bony spur on the X ray at the last follow-up were compared between the 2 groups; the flexion-extension and carrying angle of the elbow were compared between the healthy side and the affected side within each group at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 28 pediatric patients were followed up for (4.9±0.4) months after surgery. The incision length [(1.3±0.4) cm] and Kirschner wire removal time [(42.8±3.5) d] in the arthroscopic group were significantly shorter than those in the open reduction group [(4.8±0.5) cm and (95.5±16.4) d] ( P<0.05). There was no significant difference in the operation time between the 2 groups [(70.6±15.5) min versus (61.7±14.5) min] ( P>0.05). There was no significant difference in the flexion-extension or in the carrying angle between the healthy and affected sides within each group at the last follow-up ( P>0.05). There was no significant difference either in the MEPS score or in the incidence of lateral bony spur between the 2 groups at the last follow-up ( P>0.05). Follow-up revealed pin infection in 1 patient in the arthroscopic group, and exposure of Kirschner wire tail in 1 patient in the open reduction group. Conclusions:In the treatment of humeral lateral condylar fractures, arthroscopically assisted reduction and Kirschner wire fixation can allow for debridement of the fracture ends in a minimally invasive way, visual fracture evaluation and reduction. Compared with open reduction, arthroscopically assisted reduction can reduce operative trauma without significantly increasing operation time.
