| Objective: 1.To compare the differences in difficulty of closed reduction between extensionradial type Gartland III supracondylar fracture of humerus in children and extension-ulnar type Gartland III supracondylar fracture of humerus in children.2.To demonstrate the superiority of trans-capitulum humeri "joystick technique" assisted closed reduction in the treatment of children with extension-radial type Gartland III supracondylar fracture of humerus.3.To quantify the relationship between the horizontal rotation rate of Gartland Ⅲ supracondylar fracture of humerus and the corresponding true degree of rotational deformity.Methods: This study was divided into two parts: clinical retrospective analysis and experimental study.The specific methods are as follows: 1.A total of 243 children with GartlandⅢ extension-type supracondylar fracture of humerus who were treated in in the Children’s Orthopaedic Medicine Center,the Second Affiliated Hospital of Inner Mongolia Medical University from January 2020 to October 2022 were included in the study,156 cases(64.20%)of children with ulnar-type fracture treated by closed reduction and percutaneous pinning(CRPP)were divided into Group A;45 cases(18.52%)of children with radial-type fracture treated by CRPP were divided into Group B;42 cases(17.30%)of children with radial-type fracture treated by trans-capitulum humeri "joystick technique" assisted closed reduction were divided into Group C.Anova was adopted for measurement data and Chi-square test adopted for counting data to compare the differences in intraoperative operation,reduction quality,follow-up results and postoperative complications.2.The relationship between the horizontal rotation rate and the true rotation degree of the two most common Gartland Ⅲ supracondylar fractures(low transverse and lateral oblique)was quantified using left and right humerus specimens from a child cadaver.The horizontal rotation rates of each angle were measured and calculated independently by 2 observers using medial radiographs of fracture model rotated ranging from 0° to 45° for single factor linear regression analysis.Results: 1.A total of 243 children were followed up for(1.31 ± 0.33)years;clinical healing results of the fractures were obtained from 4 to 6 weeks after surgery.The operative time and number of fluoroscopies were(26.72±6.66)mins and(20.36±3.17)in group A,(43.32±12.8)mins and(40.22±7.67)in group B,and(30.80±6.40)mins and(22.43±3.20)in group C.The differences between groups A and B were statistically the difference between groups A and B was statistically significant(p<0.05),and the difference between groups B and C was statistically significant(p<0.05).The coronal plane Baumann angles at 16 weeks postoperatively and at the last follow-up were(72.38±1.8)° and(73.33±1.48)° in group A,(70.21±2.48)° and(70.31±3.39)° in group B,and(73.13±1.36)° and(72.66±1.54)° in group C,respectively.The differences between groups A and B were the difference between groups A and B was statistically significant(p<0.05),and the difference between groups B and C was statistically significant(p<0.05).By the time of the final follow-up,there was a statistical difference between group B and the healthy side within the group(p<0.05).The Baumann angle in the lateral sagittal plane was restored to the normal range in all three groups of children.At16 weeks postoperatively,elbow flexion and extension were(139.52±5.53)° and(-1.22±1.52)°in group A,(132.55±5.45)° and(-3.50±3.71)° in group B,and(132.23±6.16)° and(-2.77±2.41)° in group C,respectively.The difference between groups A and B was statistically significant,(p<0.05),and the difference between groups B and C was not statistically significant.By the time of the last follow-up,the degree of elbow flexion and extension had basically returned to normal in all three groups,with no statistically significant difference between groups and no statistically significant difference within the group compared with the healthy side.There was no statistically significant difference in the good rate of elbow function using Flynn’s criteria at 16 weeks postoperatively and at the last follow-up in the three groups.2.Both types of fractures exhibited a linear increase in the horizontal rotation rate in the range of 0° to 45°.Univariate linear regression revealed that the horizontal rotation rate increased by 0.016(R~2 =0.997)per 1° of rotation for low transverse fractures and by 0.019(R~2 = 0.992)per 1° of rotation for lateral oblique fractures.The true degrees of rotation for these 2 types of fractures at 1.15 was 9.31° and 9.79°,respectively.Conclusion: 1.In the treatment of Gartland Ⅲ extension-type supracondylar fracture of humerus,the reduction of radial-type fracture is significantly more difficult than that of ulnartype fracture.2.Compared with the CRPP,the "joystick technique" assisted closed reduction through the humeral tuberosity has significant advantages over the CRPP in the treatment of Gartland III supracondylar humeral fractures in children with extension and radial deviation,which further optimizes the closed reduction process and reduces the probability of surgical risk.3.For Gartland Ⅲ extension-type supracondylar fracture of humerus,the true degree of distal rotation is linearly correlated with the horizontal rotation rate,and the horizontal rotation rate increases by 0.015 ～ 0.020 with every 1° increase in the degree of rotation. |
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