| Part 1 Clinical Study of Early、Delayed and Neglected Treatment of Gartland type Ⅲ Supracondylar Humerus Fractures in Children with Closed Reduction and Internal Fixation with 3 Kirschner Wires on the Radial SideObjective: To compare the clinical effect of closed reduction and three Kirschner wires internal fixation on the radial side in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children at different surgical timing,in order to find the correlation between the surgical timing and the treatment prognosis,and to provide clinical basis for orthopedic surgeons in children.Methods:A retrospective study was conducted to collect clinical data of 206 cases of Gartland typeⅢsupracondylar fractures of humerus treated with closed reduction and percutaneous pinningin the Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to January 2021 according to case selection criteria.According to the different treatment time,the children were divided into six groups:72 children from injury to operation time≤24 hours were classified as early operation group,and this group was further divided into two surgical treatment groups≤12 hours and 12～24 hours,including 22 children in the former group(defined as≤12 hours group)and 50 children in the latter group(defined as 12～24 hours group).A total of 133 children with 24 hours～1 week from injury to operation were classified as delayed operation group,and this group was further subdivided into three operation treatment groups of 24～48 hours、48～72 hours and 72 hours～1 week.Among them,52 children in the former group(defined as the 24～48 hours group),31children in the middle group(defined as the 48～72 hours group),and 30 children in the latter group(defined as the 72hours～1 week group);Twenty-one patients with injury and operation time of 1～3 weeks were classified as neglected operation group(defined as 1～3weeks with callus formation group).The clinical baseline data of the six groups were compared to ensure comparability among the groups.The intraoperative data of the children were compared to explore the influence of different operation timing on the operation process.Flynn elbow function score and elbow range of motion recovery were used to evaluate elbow functional recovery at the last follow-up to observe the incidence of complications.Results:There was no significant difference in preoperative general clinical data between the 6 groups(P>0.05),indicating comparability among the 6 groups of samples.The6 groups were followed up for 39.4(29.8,52.4)weeks(ranging from 24.0 to 76.9 weeks),and the fracture was clinically healed 4 to 6 weeks after surgery.In terms of intraoperative operation time and fluoroscopy,the operation time[19.8(16.7,28.5)min,22.3(16.2,27.3)min]and fluoroscopy times[20(16,25),23(14,26)]of the≤12 hours and 12～24 hours groups in the early treatment group were all less than those of the 24～48 hours group in the delayed treatment group[26.1(21.5),32.5)min,27(22,33)times],48～72 hours group[28.5(23.9,32.2)min,28(24,34)times]and 72 hours～1 week group[33.1(27.9,39.7)min,34(29,39)times]and neglected 1～3 weeks with callus formation[38.5(28.7,46.0)min,40(30,47)times],the differences were statistically significant(P<0.05);Operation time[26.1(21.5,32.5)min,28.5(23.9,32.2)min]and fluoroscopy times[27(22,33),28(24,34)times]in the 24～48 hours and 48～72 hours delayed treatment group were all less than those in the1～3 weeks neglected treatment group with callus formation[38.5(28.7,46.0)min,40(30,47)times],the differences were statistically significant(P<0.05);There was no significant difference in the operation time[33.1(27.9,39.7)min]and fluoroscopy times[34(29,39)times]between the 72 h～1 week delayed treatment group and the 1～3 week neglected treatment group with callus formation[38.5(28.7,46.0)min,40(30,47)times](P>0.05).At the last follow-up,in terms of flynn’s rate of elbow function,the neglected treatment group(81.0%)was lower than the early treatment group[≤12 hours group(95.5%),12～24 hours group(100%)]and the delayed treatment group[24～48 hours group(98.1%),48～72 hours group(93.6%),72 hours～1 week group(96.7%)],the difference was statistically significant(P<0.05);The difference between early treatment group[≤12 hours group(95.5%),12～24 hours group(100%)]and delayed treatment group[24 to 48 hours group(98.1%),48～72 hours group(93.6%),72 hours～1 week group(96.7%)]was not statistically significant(P>0.05).In terms of complications,the incidence of elbow varus deformity in the neglected treatment group was higher than that in the early treatment group and the delayed treatment group,and the difference was statistically significant(P<0.05);There were no statistically significant differences in the complications of pinus infection and myositis ossificans among the 6 groups(P>0.05).Conclusions:(1)Early operation and delayed operation in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children are equally effective,and both can achieve satisfactory clinical results.(2)The difficulty of closed reduction of Gartland type Ⅲsupracondylar fracture of humerus in children with CRPP neglected for 1～3 weeks,and the postoperative complications and final prognosis are difficult to predict,so the treatment should be treated with caution.Part 2 Biomechanical Analysis of Cubitus Varus Deformity after Supracondylar Humerus Fractures in ChildrenObjective: In order to reduce the incidence of elbow varus deformity after supracondylar humerus fractures in children,biomechanical experiments were conducted in this study to analyze and evaluate the biomechanical characteristics of different Kirschner wire fixation methods and their influence on the stability of fracture fixation,so as to provide a theoretical basis for clinicians to choose appropriate treatment programs for children.Methods: Five normal embalmed child cadavers(1.0 ～ 3.5 years old,mean 2.4 years old)were selected to obtain 10 distal humerus specimens,a guide assisted bone knife was used to perform transverse osteotomy 1.0cm above the interlateral condylar line of the humerus,and supracondylar fracture models of the humerus were established.Anatomical reduction was achieved for each fracture model,and 1.5mm Kirschner wire was used for fixation.They were divided into two different fixation methods: 1 ulnar、2 cross Kirschner wires(cross fixation group)and 3 fan shaped Kirschner wires(radial fixation group).All specimens were tested after axial torsion loading to obtain the observed values of torsional strength of different fixation methods.Results:Torsion testing machine was used to measure and record the corresponding torques required for the 5°,10°,15°,20°and 25°inward torsion generated at the distal end of fracture in the two groups of specimens.The experimental data of the two groups were analyzed by SPSS22.0 statistical software,and the results showed that,The 1 ulnar and 2radially crossed Kirschner wires internal fixation group provided stronger mechanical stability than the 3 radially fan-shaped Kirschner wires fixation group.In contrast,the average torsional torque required for 5°rotation was reduced by 47.83%when three sector Kirschner wires were fixed on the radial side,and the difference was not statistically significant(P>0.05);The average torsional torque required for 10°rotation was reduced by 46.59%,and the difference was statistically significant(P<0.05).The torsional torque required to generate 25°was reduced by 46.86%on average,and the difference was statistically significant(P<0.001).Conclusions: The cross fixation group has better biomechanical stability than the radial fixation group,and can maximize the prevention of elbow varus deformity caused by rotation and displacement of distal fracture end after reduction of supracondylar humerus fractures in children. |
PDF Full Text Request