| [Objective](1) To observe the children’s elbow anatomical imaging features by autopsy offering clinical services.(2) To compare the efficacy of medial-lateral entry pinning versus lateral entry pinning for extension supracondylar fractures of the humerus in children in meta-analysis.[Methods]1. autopsy and imagingObservation of a few content by20sides of the10elbow cadavers of children and DR-X-ray radiography system:(1) To observe the imaging structure of children’s elbow;(2) To explore the variation of relationship of the anterior humeral line to the capitellar ossific nucleus;(3) To explore the anatomical structure of the teardrop shadow of the distal humerus;(4)To observe the changes of imaging characteristics by producing supracondylar fracture model;(5)To observe anteverted angulation of the capitellum and trochlea.2.meta-analysis of supracondylar fracturesWe searched and collected randomized controlled trials (RCTs) through searching databases (Cochrane central register of controlled trials,Medline,EMbase and the China Biological Medicine Database).The equality of the included studies was critically assessed. The Measurement index includes Iatrogenic ulnar nerve injury incidence, cany ing angle loss, baumann angle loss,humerocapitellar angle loss,pin-track infection incidence,Rate of excellent or good outcome by flynn criteria.Data analyses were performed with the statistical software Revman5.1.[Results](1)autopsy and imaging1. The elbow is constituted by the humeroulnar joint, humeroradiai joint and the proximal radioulnar jiont. And the cartilage and ossification centers compose the articulation. Elbow epiphysis is consist of6epiphysis, including capitellum, lateral condyle humerus, trochlea, Medial epicondyle of Humerus, capitulum radii and the olecranon.2. The anterior humeral line passes through the posterior third of the capitellum in four limbs and the middle third in16limbs., and their relationship is not subject to the different angle of elbow flexion.3. The anterior, posterior,and lower dense shadow of The teardrop shadow are respectively form of the front edge of the coronary fossa, the back edge of the olecranon fossa and the bone under the epiphyseal plate of humeral metaphyseal facing the trochlea.4. The degree of anteverted angulation of the capitellum and trochlea are42.63°±2.24and10.58°±2.82°(2)meta-analysis of supracondylar fracturesFive RCTs were included.The results of meta-analysis showed that there were statistically significant differences in Iatrogenic ulnar nerve injury incidence[RR=3.31,95%CI(1.04,10.52), P=0.04] between medial-lateral entry pinning and lateral entry pinning groups. And no statistically significant differences were found in carrying angle loss [WMD=-0.03,95%CI(-0.38,0.32), P=0.87], baumann angle loss[WMD=-0.10,95%CI(-0.34,0.13), P=0.40],humerocapitellar angle loss[WMD=0.04,95%CI(-0.22,0.31), P=0.75],pin-track infection incidence[RR=2.17,95%CI(0.50,9.33) P=0.94],Rate of excellent or good outcome by flynn criteria[RR=0.99,95%CI(0.91,1.07), P=0.77].[Conclusions]1.The anterior humeral line not always passes through the middle third of the capitellum, so it is not reliable to diagnose the occult supracondylar fractures of humerus2.The anterior, posterior,and lower dense shadow of The teardrop shadow are respectively form of the front edge of the coronary fossa, the back edge of the olecranon fossa and the bone under the epiphyseal plate of humeral metaphyseal facing the trochlea.And we can take the change of the teardrop shadow for diagnosis of the occult supracondylar fractures of humerus.3. The degree of anteverted angulation of the capitellum and trochlea are42.63°±2.24and10.58°±2.82°,which can offer basic for the fracture restoration.4. Iatrogenic ulnar nerve injury incidence in medial-lateral entry pinning group is higher than lateral entry pinning group, and The equivalent curative effect is found in mechanical stability, pin-track infection incidence,rate of excellent or good outcome by flynn criteria between the two group. |
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