Abstract
Objective:To compare the clinical efficacy and safety of closed reduction versus open reduction and crossed Kirschner wire(K-wire)internal fixation in the treatment of Gartland type Ⅲ supracondylar humeral fractures(SCHFs)in children.Methods:The medical records of 133 children with Gartland type Ⅲ SCHFs treated at Hangzhou Children's Hospital from January 2020 to December 2024 were analyzed retrospectively.Among them,77 children underwent closed reduction and crossed K-wire internal fixation(closed reduction group),and 56 ones with open reduction and crossed K-wire internal fixation(open reduction group).The operative time,hospital stay,intr-aoperative blood loss,fracture healing time,affected limb pain visual analogue scale(VAS)score evaluated at 24-hour post-surgery,fracture healing status at 3-and 6-month post-surgery,carrying angle and Baumann angle,comprehensive therapeutic outcome evaluated at 6-month post-surgery,as well as the incidence of complications,were compared between the two groups.Results:①General outcomes.The closed re-duction group showed shorter operative time,hospital stay,and fracture healing time compared to the open reduction group(t=20.256,P=0.000;t=15.692,P=0.000;t=15.553,P=0.000),as well as less intraoperative blood loss(t=53.236,P=0.000)and lower affected limb pain VAS score evaluated at 24-hour post-surgery(t=39.601,P=0.000).②Fracture healing status.At 3-and 6-month post-surgery,the closed reduction group showed superior fracture healing compared to the open reduction group(x2=9.872,P=0.002;x2=17.015,P=0.000).③Carrying angle and Baumann angle.No significant differences were observed between the two groups in carrying angle or Bau-mann angle at 3-and 6-month post-surgery(carrying angle:t=0.533,P=0.595;t=0.377,P=0.707;Baumann angle:t=0.103,P=0.918;t=1.392,P=0.166).④Comprehensive therapeutic outcome.At 6-month post-surgery,the closed reduction group achieved excel-lent outcome in 40 cases,good in 22 cases,fair in 12 cases,and poor in 3 cases;the open reduction group achieved excellent outcome in 13 cases,good in 20 cases,fair in 12 cases,and poor in 11 cases.The closed reduction group demonstrated significantly better comprehen-sive outcomes than the open reduction group(Rclosed reduction group=56.990,Ropen reduction group=80.760,Z=-3.705,P=0.000).⑤Safety.Twelve children in the closed reduction group and 16 cases in the open reduction group experienced mild ulnar and radial nerve injuries.No complications such as pin tract infection,fracture re-displacement,or elbow joint stiffness were observed in either group.There was no sig-nificant difference in the incidence of complications between the two groups(x2=3.290,P=0.070).Conclusion:Both closed reduction and open reduction combined with crossed K-wire internal fixation can effectively restore the normal anatomical structure of the distal hume-rus with high safety in treatment of Gartland type Ⅲ SCHFs in children.However,compared to open reduction,the closed reduction offers ad-vantages such as shorter operative time and hospital stay,less intraoperative blood loss,and reduced post-surgery pain,which are more con-ducive to fracture healing.Its comprehensive efficacy is better than that of open reduction.关键词
肱骨骨折/骨折固定术,内/骨折闭合复位/骨折切开复位/骨钉/儿童/临床试验专题Key words
humeral fractures/fracture fixation,internal/closed fracture reduction/open fracture reduction/bone nails/child/clinical trials as topic
