科研之友
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摘要
Objective: To determine the 3-dimensional morphology of pediatric lateral condylar physeal fractures using 3-dimensional computed tomography (3D-CT) and to identify optimal pin positions for percutaneous pinning. Design: Prospective case series of consecutively treated patients. Setting: Tertiary university hospital setting. Patients: Preoperative 3D-CTs in pediatric surgical candidates diagnosed with lateral condylar physeal fractures. Intervention: Closed reduction and percutaneous pinning was performed. Main Outcome Measures: Reconstructed images of the distal humerus were aligned accordingly to determine the coronal (a), sagittal (b), and axial tilt (g) angles of the fracture plane. Both a and b were also measured on plain radiography. Image-based position of the 2 pins was calculated preoperatively using 3D-CT, based on anteroposterior and lateral views. Final angle of pins was measured on postoperative radiographs. Results: A total of 29 fractures were assessed. 3D-CT reconstruction images of fractures showed a posterolateral fracture fragment with reference to the long axis of the humerus. The mean a, b, and g were 62 degrees [95% confidence interval (CI), 59-64], 69 degrees (95% CI, 65-72), and 36 degrees (95% CI, 34-38). Both a and b measured on plain radiography were not significantly different from 3D-CT measurements (P = 0.6712, 0.6218). Average postoperative pin angles were 144 degrees (95% CI, 140-147) and 161 degrees (95% CI, 158-165) for the proximal pin, and 118 degrees (95% CI, 114-122) and 115 degrees (95% CI, 110-120) for the distal pin, on anteroposterior and lateral views, respectively, resulting in similar trajectories to the preoperatively calculated pin positions. Conclusion: Our study adds to the current knowledge by providing an image-based angular reference of the fracture configuration in pediatric lateral humeral condyle fractures, which may be used during percutaneous pinning.
- 出版日期2017-10
