Переломы дистального метафиза плечевой кости у детей: этиопатогенез, клиника, диагностика, лечение

Актуальность. Переломы дистального метафиза плечевой кости – самые распространённые среди травм костей локтевого сустава у детей, наблюдаются в 64–70% случаев. Цель — обобщение, систематизация литературных данных и представление современных взглядов на эпидемиологию, этиологию, патогенез, диагностику и лечение надмыщелковых и чрезмыщелковых переломов плечевой кости у детей. Материалы и методы. Системный поиск литературы был проведён по базам данных PubMed, PubMed Central, Web of Science, Scopus, MEDLINE, eLIBRARY, РИНЦ, Google Scholar, Cyberleninka, eLibrary и др. В исследование включались публикации о переломах дистального метафиза плечевой кости, лечении надмыщелковых и чрезмыщелковых переломов плечевой кости у детей в возрастной категории от 1 года до 17 лет включительно. Результаты. Дистальные метефизарные переломы плечевой кости являются самыми частыми среди переломов локтевого сустава у детей. Лечение переломов без смещения I-типа по Gartland проводится консервативно. Предпочтительным методом лечения переломов со смешением (типа II, III и VI по Gartland) является закрытая репозиция с чрескожным остеосинтезом спицами. При неуспешных попытках выполнения закрытой репозиции или при развитии серьёзных сосудисто-неврологических нарушений применяется открытая репозиция с ревизией области перелома. Оперативные вмешательства с остеосинтезом дистальных переломов плечевой кости в разы увеличились за последние годы, но значительно уменьшилось количество корригирующих остеотомий в лечении посттравматических деформаций. Заключение. Правильный подход в диагностике и лечении дистальных метефизарных переломов плечевой кости у детей, разумный выбор метода оперативного лечения и техники остеосинтеза обеспечивают положительные результаты лечения, уменьшают риск развития осложнений на протяжении всех этапов периода лечения.

1. Wang H, Feng C, Liu H, et al. Epidemiologic Features of Traumatic Fractures in Children and Adolescents: A 9-Year Retrospective Study. Biomed Res Int. 2019;2019:8019063. https://doi.org/10.1155/2019/8019063

2. Merckaert S, Chaibi E, Meriem S et al. Epidemiology of Pediatric Upper Extremity Fractures in Tertiary Care Center in Switzerland [published online ahead of print, 2020 Feb 27]. Pediatr Emerg Care. 2020;10.1097/PEC.0000000000002047. https://doi.org/10.1097/PEC.0000000000002047

3. Морозов С.Ю., Тучик Е.С., Морозов Ю.Е. Судебно-медицинские аспекты оценки переломов костей, составляющих локтевой сустав у детей. Медицинская экспертиза и право. 2015;1:31-35.

4. Hussain S, Dar T, Beigh AQ, et al. Pattern and epidemiology of pediatric musculoskeletal injuries in Kashmir valley, a retrospective singlecenter study of 1467 patients. J Pediatr Orthop B 2015;24:230–237.

5. Issin A, Kockara N, Oner A, Sahin V. Epidemiologic properties of pediatric fractures in a metropolitan area of Turkey. Medicine (Baltimore) 2015;94:e1877.

6. Baig MN. A Review of Epidemiological Distribution of Different Types of Fractures in Paediatric Age. Cureus. 2017;9(8):e1624. https://doi.org/10.7759/cureus.1624

7. Rodríguez-Martínez JJ, Mora-Ríos FG, Mejía-Rohenes LC. Pediatric traumatic elbow frequency in Hospital Regional General Ignacio Zaragoza. Rev Esp Med Quir. 2018;23(2):87-92.

8. Tepeneu N.F. Fractures of the Humeral Condyles in Children. A Review Journal of Medical and Psychological Trauma. 2018;1(1):3-13.

9. Pilla NI, Rinaldi J, Hatch M, Hennrikus W. Epidemiological Analysis of Displaced Supracondylar Fractures. Cureus. 2020;12(4):e7734. https://doi.org/10.7759/cureus.7734

10. Okubo H, Nakasone M, Kinjo M et al. Epidemiology of paediatric elbow fractures: a retrospective multi-centre study of 488 fractures. J Child Orthop. 2019;13(5):516-521. https://doi.org/10.1302/1863-2548.13.190043

11. Anjum R, Sharma V, Jindal R et al. Epidemiologic pattern of paediatric supracondylar fractures of humerus in a teaching hospital of rural India: A prospective study of 263 cases. Chin J Traumatol. 2017;20(3):158-160. https://doi.org/10.1016/j.cjtee.2016.10.007

12. Wilkins KE. Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, King RE, editors. Fractures in children. 3rd ed. Philadelphia: JB Lippincott; 1991. p. 526–617.

13. Ryan LM, Bachur RG, Wiley JF. Evaluation and management of supracondylar fractures in children. UpToDate. Waltham (MA): UpToDate. 2009.

14. Smuin DM, Hennrikus WL. The Effect of the Pucker Sign on Outcomes of Type III Extension Supracondylar Fractures in Children. J Pediatr Orthop. 2017;37(4):e229-e232. https://doi.org/10.1097/BPO.0000000000000893

15. Louahem D, Cottalorda J. Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus. Injury. 2016;47(4):848-852. https://doi.org/10.1016/j.injury.2016.01.010

16. Franklin CC, Skaggs DL. Approach to the pediatric supracondylar humeral fracture with neurovascular compromise. Instr Course Lect. 2013;62:429-433.

17. Dhoju D, Shrestha D, Parajuli N et al. Ipsilateral supracondylar fracture and forearm bone injury in children: a retrospective review of thirty one cases. Kathmandu Univ Med J (KUMJ). 2011 Apr-Jun;9(34):11-6. https://doi.org/10.3126/kumj.v9i2.6280. PMID: 22610861

18. Goldfarb CA, Patterson JM, Sutter M, Krauss M, Steffen JA, Galatz L. Elbow radiographic anatomy: measurement techniques and normative data. J Shoulder Elbow Surg. 2012;21(9):1236-1246. https://doi.org/10.1016/j.jse.2011.10.026

19. Kao HK, Lee WC, Yang WE, Chang CH. Clinical significance of anterior humeral line in supracondylar humeral fractures in children. Injury. 2016;47(10):2252-2257. https://doi.org/10.1016/j.injury.2016.06.037

20. Weiland A. In: The elbow and its disorders. 3. Morrey B, editor. Philadelphia: WB Saunders; 2000. p. 13–42.

21. Johnson, Thomas R., Lynne S. Steinbach, eds. Essentials of musculoskeletal imaging. American Academy of Orthopaedic Surgeons, 2004.

22. Madjar-Simic I, Talic-Tanovic A, Hadziahmetovic Z, Sarac-Hadzihalilovic A. Radiographic assessment in the treatment of supracondylar humerus fractures in children. Acta Inform Med. 2012;20(3):154-159. https://doi.org/10.5455/aim.2012.20.154-159

23. Samelis PV, Papagrigorakis E, Ellinas S. Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method. Cureus. 2019;11(10):e6024. Published 2019 Oct 29. https://doi.org/10.7759/cureus.6024

24. Баиров Г. А. Детская травматология. 2-е изд. СПб.: Питер, 2000. Bairov G.A. Detskaya travmatologiya. 2nd ed. Saint Petersburg: Piter; 2000. (In Russ).

25. Amir S, Jannis S, Daniel R. Distal humerus fractures: a review of current therapy concepts. Curr Rev Musculoskelet Med. 2016;9(2):199-206. https://doi.org/10.1007/s12178-016-9341-z

26. Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J. 2017;11:1292- 1307. https://doi.org/10.2174/1874325001711011292

27. Jupiter JB, Mehne DK. Fractures of the distal humerus. Orthopedics. 1992;15(7):825-833.

28. Juan P. Simone 44 - Low Transcondylar Fractures of the Distal Humerus, Editor(s): Bernard F. Morrey, Joaquin Sanchez-Sotelo, Mark E. Morrey,Morrey's the Elbow and its Disorders (Fifth Edition), Elsevier, 2018:440-449. https://doi.org/10.1016/B978-0-323-34169-1.00044-9 (https://www.sciencedirect.com/science/article/pii/B9780323341691000449)

29. Cepela DJ, Tartaglione JP, Dooley TP, Patel PN. Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures. Clin Orthop Relat Res. 2016;474(11):2531-2537. https://doi.org/10.1007/s11999-016-4891-3

30. Beckmann NM, Crawford L. Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography. Radiol Case Rep. 2017;12(3):571-576. https://doi.org/10.1016/j.radcr.2017.04.013

31. Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res. 2015;473(2):738-741. https://doi.org/10.1007/s11999-014-4033-8

32. Barton KL, Kaminsky CK, Green DW, Shean CJ, Kautz SM, Skaggs DL. Reliability of a modified Gartland classification of supracondylar humerus fractures. J Pediatr Orthop. 2001;21(1):27-30. https://doi.org/10.1097/00004694-200101000-00007

33. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32 Suppl 1:S1-S170. https://doi.org/10.1097/BOT.0000000000001063

34. Slongo TF, Audigé L; AO Pediatric Classification Group. Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma. 2007;21(10 Suppl):S135-S160. https://doi.org/10.1097/00005131-200711101-00020

35. Joeris A, Lutz N, Blumenthal A, Slongo T, Audigé L. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop. 2017;88(2):123-128. https://doi.org/10.1080/17453674.2016.1258532

36. Audigé L, Slongo T, Lutz N, Blumenthal A, Joeris A. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop. 2017;88(2):133-139. https://doi.org/10.1080/17453674.2016.1258534

37. Battaglia TC, Armstrong DG, Schwend RM. Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop. 2002;22(4):431-439.

38. Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013;95(1):28-34. https://doi.org/10.2106/jbjs.l.00132

39. Pham TT, Accadbled F, Abid A, et al. Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe? J Shoulder Elbow Surg. 2017;26(12):2226-2231. https://doi.org/10.1016/j.jse.2017.05.018

40. Muccioli C, ElBatti S, Oborocianu I, et al. Outcomes of Gartland type III supracondylar fractures treated using Blount's method. Orthop Traumatol Surg Res. 2017;103(7):1121-1125. https://doi.org/10.1016/j.otsr.2017.06.011

41. Park MJ, Ho CA, Larson AN. AAOS Appropriate Use Criteria: Management of Pediatric Supracondylar Humerus Fractures. J Am Acad Orthop Surg. 2015;23(10):e52-e55. https://doi.org/10.5435/JAAOS-D-15-00408

42. Howard A, Mulpuri K, Abel MF, et al. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg. 2012;20(5):320- 327. https://doi.org/10.5435/JAAOS-20-05-320

43. Yang J, Wang T, Tian NF, et al. Supracondylar humeral fractures in children: American Academy of Orthopaedic Surgeons appropriate use criteria versus actual management in a teaching hospital. J Child Orthop. 2019;13(4):404-408. https://doi.org/10.1302/1863-2548.13.190081

44. Wang JH, Morris WZ, Bafus BT, Liu RW. Pediatric Supracondylar Humerus Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Pediatric Level 1 Trauma Center. J Pediatr Orthop. 2019;39(8):e578-e585. https://doi.org/10.1097/BPO.0000000000001096

45. Novais EN, Andrade MA, Gomes DC. The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop. 2013;33(1):14-19. https://doi.org/10.1097/BPO.0b013e3182724d07

46. Abbott MD, Buchler L, Loder RT, Caltoum CB. Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration. J Child Orthop. 2014;8(6):473-477. https://doi.org/10.1007/s11832-014-0624-x

47. Shon H-C, Kim JW, Shin H-K, et al. Does the timing of surgery affect outcomes of Gartland type III supracondylar fractures in children? Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):25-32. https://doi.org/10.17816/PTORS7225-32

48. Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007;27(2):181-186. https://doi.org/10.1097/bpo.0b013e3180316cf1

49. Kamara A, Ji X, Liu C, Liu T, Wang E. The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model. Injury. 2021;52(6):1310-1315. https://doi.org/10.1016/j.injury.2021.01.012

50. Gottschalk HP, Sagoo D, Glaser D, Doan J, Edmonds EW, Schlechter J. Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter?. J Pediatr Orthop. 2012;32(5):445-451. https://doi.org/10.1097/BPO.0b013e318257d1cd

51. Liu C, Kamara A, Liu T, Yan Y, Wang E. Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis. J Orthop Surg Res. 2020;15(1):34. https://doi.org/10.1186/s13018-020-1564-4

52. Kow RY, Zamri AR, Ruben JK, Jamaluddin S, Mohd-Nazir MT. Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring. Malays Orthop J. 2016;10(2):41-46. https://doi.org/10.5704/MOJ.1607.008

53. Bell P, Scannell BP, Loeffler BJ, et al. Adolescent Distal Humerus Fractures: ORIF Versus CRPP. J Pediatr Orthop. 2017;37(8):511-520. https://doi.org/10.1097/BPO.0000000000000715

54. Pesenti S, Ecalle A, Gaubert L, et al. Operative management of supracondylar humeral fractures in children: Comparison of five fixation methods. Orthop Traumatol Surg Res. 2017;103(5):771-775. https://doi.org/10.1016/j.otsr.2017.05.008

55. Швед С. И., Сысенко Ю. М., Знаменский Г. Б. Лечение переломов плечевой кости у детей методом чрескостного остеосинтеза по Илизарову. Гений ортопедии. 1996;1:66-70.

56. Gugenheim JJ Jr. The Ilizarov fixator for pediatric and adolescent supracondylar fracture variants. J Pediatr Orthop. 2000;20(2):177-182.

57. Dabash S, Gerzina C, Prabhakar G, Thabet AM, Jeon S, Heinrich SD. Screw fixation for supracondylar humerus fractures in children: a report of seventeen cases. Eur J Orthop Surg Traumatol. 2019;29(3):575-581. https://doi.org/10.1007/s00590-018-2316-6

58. Ersan O, Gonen E, İlhan RD, Boysan E, Ates Y. Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children. J Pediatr Orthop B. 2012;21(2):121-126. https://doi.org/10.1097/BPB.0b013e32834dd1b2]

59. Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018;3(10):526-540. https://doi.org/10.1302/2058-5241.3.170049

60. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253-263. https://doi.org/10.1097/BPO.0b013e3181d213a6

61. Wang SI, Kwon TY, Hwang HP, Kim JR. Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study. Medicine (Baltimore). 2017;96(25):e7148. https://doi.org/10.1097/MD.0000000000007148

62. Koch PP, Exner GU. Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity. J Pediatr Orthop B. 2003;12(2):116-122. https://doi.org/10.1097/01.bpb.0000049571.52224.c8

63. Salonen A, Niemi ST, Kannus P, Laitakari E, Mattila VM. Increased incidence of distal humeral fracture surgery and decreased incidence of respective corrective osteotomy among Finns aged 0 to 18 years between 1987 and 2016: a population-based study. J Child Orthop. 2019;13(4):399-403. https://doi.org/10.1302/1863-2548.13.190049