Is bioabsorbable screw an alternative choice for displaced medial epicondylar fractures in adolescents

Abstract

In adolescent patients, cannulated lag screw (CLS) is a widely accepted choice for fixation of the medial epicondylar fracture of the humerus (MEFH). Absorbable implants, including rod, screw, and mini-plate, have been reported in children. However, to the best of our understanding, this study is the first head-to-head comparative study of CLS versus bioabsorbable screw (BS) in the treatment of MEFH. Patients of MEFH operated at our institute, from January 2010 to January 2016, were reviewed retrospectively. The patients were divided into 2 groups, the CLS group and the BS group, as per the type of implant the patient received. The CLS group consisted of 35 patients, whereas the BS group consisted of 30 patients. Demographic data, including sex, age at the time of surgery, operated side, and implant material, were collected from the hospital database. Elbow range of motion (ROM), radiographic manifestation was recorded during the out-patient visit. The elbow joint function was evaluated according to the Broberg and Morrey elbow scale and Mayo elbow performance index score. Thirty patients, including 18 males and 12 females, were included in the CLS group, whereas 35 patients, including 21 males and 14 females, were included in the BS group. At 6-month follow-up, elbow range of motion, Broberg and Morrey elbow scale and Mayo elbow performance index scale showed no significant difference between the 2 groups. The carrying angle was within the normal range in both groups. There was no nonunion or malunion in either group. The rate of hypoplasia or hyperplasia was low in both groups, 3.3% in CLS and 2.9% in BS. The rate of implant prominence was significantly higher in the CLS group (33.3%) than BS (0%). Both CLS and BS are safe and effective choices for displaced MEFH in adolescents. The BS can produce a satisfactory clinical outcome and is comparable to the CLS. Besides, the BS has the advantage of not needing second surgery for implant removal.

Possible Mechanism and Treatment Results of Combined Pediatric Fractures of the Humeral Lateral Condyle and Ipsilateral Ulnar Olecranon

“…The bioabsorbable material is compatible with tissue and avoids complications of the second surgery 26 . However, longer follow‐up is required to identify any bony abnormalities and inflammatory reactions in response to the bioabsorbable materials 14,27 . Furthermore, although conservative management is favored in treating minimally displaced olecranon fractures (<2 mm), 28 we performed CRPP with K‐wire fixation because of the joint instability caused by the associated lateral humeral condyle fracture.…”

“… 26 However, longer follow‐up is required to identify any bony abnormalities and inflammatory reactions in response to the bioabsorbable materials. 14 , 27 Furthermore, although conservative management is favored in treating minimally displaced olecranon fractures (<2 mm), 28 we performed CRPP with K‐wire fixation because of the joint instability caused by the associated lateral humeral condyle fracture. Most olecranon fractures classified as Mayo type IIA were treated with TBW, which is the standard method for stable fractures.…”

Fracturas controvertidas de miembro superior en niños y adolescentes: un debate basado en la evidencia

“…La osteosíntesis con materiales absorbibles ha demostrado resultados excelentes eliminando la necesidad de cirugía de retirada compensando de algún modo el superior coste del material. 57 Ante traumatismos de baja energía y en ausencia de luxación, ambos tratamientos son correctos y ofrecen buenos resultados siempre y cuando no se someta al codo a sobrecarga. [47][48][49][50][51] En caso contrario, el tratamiento conservador presentaría peores resultados como consecuencia de su mayor asociación a inestabilidad.…”