Behandlungsergebnisse operativ versorgter kindlicher suprakondylärer Humerusfrakturen

Zusammenfassung

Hintergrund: Etwa 80 % aller kindlichen distalen Humerusfrakturen sind suprakondyläre Frakturen. Patienten und Methoden: Operativ behandelte Kinder mit suprakondylären Humerusfrakturen aus den Jahren 2000–2008 wurden retrospektiv analysiert und auf Funktion, Zufriedenheit, Schmerzausmaß und mit dem MAYO Elbow Performance Score (MEPS) nachuntersucht. Ergebnisse: 46 Patienten wurden eingeschlossen. Offene Frakturen (2 %) oder Gefäß- (0 %) und Nervenschäden (4 %) waren selten, begleitende Unterarmfrakturen (15 %) häufig. Die Versorgung erfolgte mit geschlossener/offener Reposition und gekreuzter Kirschner-Draht-Spickung. Hauptkomplikationen waren Bewegungseinschränkung und Kirschner-Draht-Migration. Alle Frakturen heilten. 72 % der Patienten wurden Ø 51 Monate postoperativ nachuntersucht: Die durchschnittliche Differenz zwischen nicht betroffenem und betroffenem Arm betrug in Flexion 8°, in Extension 1°, in Pronation 1° und in Supination 0°. Im MEPS erreichten 88 % der Patienten exzellente oder gute Ergebnisse. Schlussfolgerung: Aufgrund der Frakturheilung in allen Fällen, gut zu beherrschenden Komplikationen, guten bis exzellenten Werten im MEPS und guter Funktion ist die gekreuzte Kirschner-Draht-Spickung nach geschlossener/offener Reposition ein sicheres Standardverfahren für die Versorgung dieser Frakturen.

Abstract

Background: About 80 % of all paediatric distal humerus fractures are supracondylar fractures. Patients and Methods: Surgically treated children with supracondylar humeral fractures between 2000–2008 were analysed retrospectively and re-evaluated for function, satisfaction, pain level and with the MAYO elbow performance score (MEPS). Results: 46 patients were included. Open fractures (2 %) and vessel (0 %) or nerve (4 %) lacerations were rare, additional forearm fractures frequent (15 %). Surgery was done by closed/open reduction and crossed K-wire pinning. Main complications were movement restriction and K-wire migration. All fractures healed. 72 % of patients could be re-evaluated Ø 51 months after surgery. The mean differences between non-affected and affected elbows showed 8° for flexion, 1° for extension, 1° for pronation and 0° for supination. In 88 % excellent or good results could be measured with the MEPS. Conclusion: Regarding bony healing in all patients, well manageable complications, mostly excellent or good results in the MEPS and good function, crossed K-wire pinning after closed/open reduction is a safe standard surgical procedure for this type of fracture.

Schlüsselwörter

Kinder - Humerus - suprakondyläre Fraktur - chirurgische Behandlung - Analyse des Outcomes

Key words

children - humerus - supracondylar fractures - surgical treatment - outcome analysis

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