探讨儿童肱骨外髁骨折合并肘关节脱位的临床特点及基于骨折块相对宽度的分类对诊治的指导价值。

回顾性分析苏州大学附属儿童医院骨科2021年8月至2024年10月期间收治的19例肱骨外髁骨折合并肘关节脱位患者的临床资料，纳入年龄＜16岁、影像学确诊且随访资料完整者；排除开放伤、严重复合伤、病理性骨折及既往肘关节畸形或手术史者。根据骨块横径/肱骨外髁宽度分为两组。结构性不稳组（SI组）：平均相对宽度＞50%，共14例；韧带性不稳组（LI组）：平均相对宽度＜20%，共5例。采用t检验、Mann-Whitney U检验及Fisher精确检验比较两组患者在一般资料、脱位机制、影像学特点、治疗重点及预后等方面的差异。

两组患者在性别、年龄、损伤侧别、外伤到住院时间、神经血管损伤和住院天数等方面差异无统计学意义（均为P＞0.05）。两组影像学特征有明显差异，SI组骨折累及骺板及关节面，LI组骨折局限于干骺端或骺板外侧，关节面完整；两组采用的治疗策略不同，SI组均行手术恢复关节面解剖及骨性稳定，4例行闭合复位，10例行切开复位，其中4例辅以肘关节造影。LI组3例骨折块小、移位程度轻、关节稳定者行保守治疗，2例伴桡侧副韧带损伤者行手术治疗修补韧带。两组患儿术后Mayo评分和特种外科医院（HSS）评分差异无统计学意义（均为P＞0.05），优良率均为100.0%。所有患者均无骨折的不愈合、延迟愈合、肱骨远端缺血性坏死及肘关节畸形等并发症。

基于骨折块平均相对宽度的SI/LI分型可有效区分骨性不稳和韧带性不稳两种主要损伤模式，对影像学判断及治疗策略选择具有一定指导价值。本研究纳入病例经上述针对性治疗后均取得优良预后。

Exploring the clinical characteristics of humeral lateral condyle fracture combined with elbow dislocation in children and the guiding value of classification based on the relative width of fracture fragments for diagnosis and treatment.

A retrospective analysis was performed on the clinical data of 19 patients with lateral humeral condyle fractures (LHCF) complicated by elbow dislocation admitted to the Department of Orthopedics, Children’s Hospital of Soochow University, from August 2021 to October 2024. Inclusion criteria: age <16 years, imaging-confirmed diagnosis, and complete follow-up records. Exclusion criteria: open fractures, severe multiple trauma, pathological fractures, and a history of prior elbow deformity or surgery. Patients were divided into two groups based on the ratio of the fracture fragment’s transverse diameter to the width of the lateral humeral condyle. The structural instability (SI) group (n=14) consisted of cases with a mean relative width >50%, while the ligamentous instability (LI) group (n=5) consisted of cases with a mean relative width <20%. Independent samples t tests, Mann-Whitney U tests, and Fisher’s exact tests were utilized to compare the differences between the two groups in terms of baseline characteristics, dislocation mechanisms, imaging features, treatment priorities, and clinical outcomes.

There were no statistically significant differences between the two groups in terms of gender, age, injury side, time from injury to hospitalization, neurovascular injury, and length of hospital stay (all P>0.05). Significant differences in imaging characteristics were observed between the two groups: fractures in the SI group involved the epiphyseal plate and articular surface, while fractures in the LI group were confined to the metaphysis or the lateral aspect of the epiphyseal plate, with the articular surface remaining intact. Treatment strategies also differed between the groups: all patients in the SI group underwent surgery to restore articular anatomy and bony stability, including four cases of closed reduction and 10 cases of open reduction, with four cases supplemented by elbow arthrography. In the LI group, three patients with small fracture fragments, minimal displacement, and stable joints received conservative treatment, while two patients with radial collateral ligament injuries underwent surgical ligament repair. No statistically significant difference in postoperative Mayo score and Hospital for Special Surgery (HSS) score was found between the two groups (all P>0.05), and both achieved 100.0% excellent and good rate. None of the patients experienced complications such as nonunion, delayed union, avascular necrosis of the distal humerus, or elbow deformity.

The SI/LI classification, based on the average relative width of fracture fragments, effectively distinguishes between two primary injury patterns: structural instability and ligamentous instability. This classification offers significant guiding value for radiologic assessment and the selection of targeted treatment strategies. All the patients included in this study achieved excellent clinical outcomes following the specific interventions tailored to their respective injury patterns.