Adolescent Distal Humerus Fractures: ORIF Versus CRPP

Bell, Phillip G.; Scannell, Brian P.; Loeffler, Bryan J.; Brighton, Brian; Gaston, R. Glenn; Casey, Virginia F.; Peters, M.E.; Frick, Steven L.; Cannada, Lisa K.; Vanderhave, Kelly L.

doi:10.1097/bpo.0000000000000715

Cited by 27 publications

(37 citation statements)

References 21 publications

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“…Many surgeons recommend treatment of T-type distal humerus fractures with percutaneous Kirschner wire (K-wire) fixation in cases of younger patients with minimal displacement. 22 The decision to use this technique relies on the surgeon's confidence in maintaining the integrity of the medial and lateral columns. Thickened periosteum in the skeletally immature patient can further assist with fracture stability and, thus, allows for percutaneous fixation.…”

Section: Percutaneous Pinningmentioning

confidence: 99%

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Pediatric and Adolescent T-type Distal Humerus Fractures

2017

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Although fractures of the elbow are extremely common in pediatric patients, the T-type distal humerus fracture is rare and offers unique challenges. The mechanism of injury may be similar to the adult counterpart and is usually caused by a fall onto a flexed elbow or from a direct blow. Diagnosing these injuries may be difficult. They often resemble extension-type supracondylar fractures, yet the treatment algorithm is quite different. In younger patients, percutaneous pinning remains a viable option, but for older adolescents, open reduction and internal fixation provides stable fixation at the elbow and the most reliable restoration of the articular surface. Appropriate imaging, careful radiographic diagnosis, and choice of surgical technique are of paramount importance when treating young patients with this injury. Most pediatric and adolescent patients with T-type distal humerus fractures have results better than those of adults but often worse than other elbow fractures in this age group.

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Section: Percutaneous Pinningmentioning

confidence: 99%

“… 14 , 24 In minimally displaced T-type fractures, there may be a role for the percutaneous approach, as evidenced by the results of several small studies. 22 , 23 …”

Section: Percutaneous Pinningmentioning

confidence: 99%

Pediatric and Adolescent T-type Distal Humerus Fractures

2017

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“…Супракондилярні переломи дистальної плечової кістки є найчастіший перелом ліктьового суглоба у дітей і зустрічається приблизно у 12-17% усіх дитячих переломів [8,14]. Понад 90% через-і надвиросткових переломів у дітей та підлітків супроводжуються різноманітними за ступенем зміщеннями кісткових уламків [3]. Сьогодні серед спеціалістів точаться суперечки стосовно лікування дітей, що отримали подібні переломи.…”

Section: вступunclassified

“…Багато авторів дискутують щодо показань до оперативних втручань, схиляючись до консервативної тактики [2,4]. Інші дослідники не можуть прийти до згоди у питанні часу проведення оперативних втручань [3,5,13] Таким чином, в наявності проблемна ситуація, яку можна сформулювати таким чином: попри чітко окреслену тактику лікування дітей з розгинальними черезвиростковими переломами плечової кістки, що зумовлює пріоритет консервативних методів лікування, результати таких травм погано прогнозовані через часті ускладнення, що потребують зміни або корекції методів лікування. Ця проблемна ситуація робить актуальним та важливим пошук шляхів вдосконалення лікувальної тактики у дітей з розгинальними черезвиростковими переломами плечової кістки [12].…”

Section: вступunclassified

Clinical and epidemiological characteristics of transcondylar shoulder fractures in children

Guriev¹,

Trutyak²,

Obaranets³

2020

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. Objective – to determine the clinical and epidemiological characteristics of supra- and trans-condylar fractures in children and its impact on the tactics of treatment of victims with similar traumatic injuries. To perform our study, we analyzed 255 cases transvalues shoulder fractures of the humerus in children. These victims were treated at the Lviv City Children's Clinical Hospital in the period from 2013 to 2017. The age of the victims ranged from 0.5 to 18 years. In the course of the work, the method of calculating the coefficient of the polychoric index of Pearson's connection was used. It was found that the most common extensor fractures occur when falling from a height with support on the arm. The analysis of the age structure of victims with condylar fractures in children showed that most often, this injury was found in victims aged 4–6 years (41.6%). Victims aged 16-18 (1.2%) were the least frequent in the distribution. The analysis by sex in the age groups indicated that most often this injury was found in girls aged 4–6 years (50.0%). Rarely due to condylar were fractures of the shoulder found in victims aged 16–18 years. In both the male and female groups, the victims of this age group were the least frequent. Thus, in pediatric patients due to condylar fractures of the humerus are most common in the age group of 4–6 years, more common in females. Rarely due to condylar fractures of the shoulder are diagnosed in persons of both sexes in infancy (up to 1 year) and older children (16–18 years).

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“…2 Advantages of closed reduction and percutaneous pin fixation when compared with open reduction often include a smaller incision, shorter operative theater times, 3 more rapid return of movement, and less formation of heterotopic ossification. 4 However, these procedures rely on intraoperative fluoroscopic imaging to determine appropriate smooth pin placement.…”

Section: Introductionmentioning

confidence: 99%

Do fluoroscopic and radiographic images underestimate pin protrusion in paediatric supracondylar humerus and distal radius fractures? A synthetic bone model analysis

Kenney

Schlechter

2019

Journal of Children's Orthopaedics

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Purpose Fluoroscopy is commonly used to confirm acceptable position of percutaneously placed pins when treating paediatric fractures. There is a paucity of literature investigating the accuracy of fluoroscopic imaging when determining pin position relative to the far cortex of the fixated bone. The purpose of this study was to evaluate the accuracy of fluoroscopic and radiographic imaging in measuring smooth pin protrusion from the far cortex of a bone model. Methods Eight bone models were implanted with smooth pins and anteroposterior fluoroscopic and radiographic studies were obtained. All images were evaluated by orthopaedic attending physicians, residents and medical students. The length of pin protrusion from the model surface was estimated on fluoroscopic imaging and measured on radiographs and compared with actual lengths measured on the bone models. Results 20 evaluators took a total of 320 pin measurements on images of 8 models. There was a significant difference between fluoroscopic measurements compared to radiographic measurements and actual pin lengths. There was no significant difference between radiographic measurements and actual pin lengths. Level of training of examiner was not statistically significant. On average, fluoroscopic estimations of pin protrusion were 1.53 mm shorter than the actual measured length. Conclusion Fluoroscopic images underestimate the length of smooth pins protruding from a bone model surface when compared with radiographs and actual measurements. Orthopaedic surgeons using fluoroscopy should be aware of this discrepancy when assessing intraoperative fluoroscopic images to decide on acceptable implant position. Level of Evidence: Level V

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Adolescent Distal Humerus Fractures: ORIF Versus CRPP

Abstract: Level III-retrospective comparative study.

Cited by 27 publications

References 21 publications

Pediatric and Adolescent T-type Distal Humerus Fractures

Pediatric and Adolescent T-type Distal Humerus Fractures

Clinical and epidemiological characteristics of transcondylar shoulder fractures in children

Do fluoroscopic and radiographic images underestimate pin protrusion in paediatric supracondylar humerus and distal radius fractures? A synthetic bone model analysis

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