The Treatment of Upper Limb Fractures in Children and Adolescents

Kraus, Ralf; Wessel, Lucas

doi:10.3238/arztebl.2010.0903

Cited by 30 publications

(28 citation statements)

References 149 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In accordance with previously published reports, schoolchildren and adolescents were the most affected groups; and the forearm was the most common fracture location (either radius alone or in combination with the ulna), with the distal segment being mostly affected (Cheng and Shen 1993, Kraus and Wessel 2010, Schalamon et al. 2011).…”

Section: Discussionsupporting

confidence: 90%

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

et al. 2016

View full text Add to dashboard Cite

Background and purposeTo achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF.Patients and methodsWe included children and adolescents (0–17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs.ResultsOf 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures.Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents.InterpretationThe pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome.

show abstract

Section: Discussionsupporting

confidence: 90%

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

et al. 2016

View full text Add to dashboard Cite

show abstract

“…This was significantly lower (p ¼ 0.046) than in patients with screw fixation (alone or in combination with a Kirschner wire) who presented with 7 complications in 22 patients (31.8%) (►Fig. 3). Complications that were seen during the follow-up examinations were an impairment of the ROM (flexion and extension) as well as misalignment (varus), delayed consolidation, and one case of wound infection.…”

Section: Potential Factors Impacting On the Complications And On The mentioning

confidence: 91%

Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?

et al. 2020

View full text Add to dashboard Cite

Introduction The treatment of the displaced fracture of the lateral condyle of the distal humerus in children aims not only to avoid nonunion, malalignment, and impairment of the range of motion of the elbow but also to prevent delayed healing and the development of any prearthrotic deformity. To date there is no agreement on what kind of osteosynthesis should be used. So far, the screw fixation and Kirschner wire fixation have both been applied. Therefore, the goal of this study was to compare the outcome of these two methods. Materials and Methods A retrospective cohort study was undertaken including 43 patients aged 2 to 13 years who underwent osteosynthesis for a condylar fracture of the humerus over a period of 10 years. The electronic archive, including the radiological diagnostics, was analyzed. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an α level of p = 0.05. Results Kirschner wire fixation was performed in 48.9% of condylar fractures of the humerus while screw fixation (alone or in combination with a pin) was assessed with a percentage of 51.1% of the cases in this study. Screw fixation only was applied in 20.9% of fractures of the lateral condyle. The selection of the method was independent of the age of the patient (p = 0.2). The comparison of the rate of complications and an impaired range of motion after Kirschner wire osteosynthesis to the rate after screw osteosynthesis showed a significantly lower percentage for the Kirschner wire group (p = 0.046). No case of nonunion, nerve palsy, or pin migration was detected in any patient in this study. Conclusion Kirschner wire fixation of condylar humeral fractures in children resulted in a lower rate of complications than screw fixation. No case of nonunion of the fracture was found in the patients that we investigated so that we conclude that Kirschner wires sufficiently adapt the fracture in these cases. Level of Evidence Level III.

show abstract

“…Confirmed errors include: imprecise clinical assessment, misinterpretation of the radiographic findings, and inappropriate choice of treatment, absent or inadequate follow-up. The highest error rate in the treatment of paediatric fractures (77%) was found for fractures in the region of the elbow joint ( 10 ).…”

Section: Discussionmentioning

confidence: 98%

The Three Step Approach to the management of acute pediatric Monteggia lesions

Hetthéssy

Sebök²,

Vadász³

et al. 2021

Injury

View full text Add to dashboard Cite

Background: The literature places the occurrence of paediatric Monteggia lesions between 1.5% and 3% of all childhood elbow injuries. There are circumstances, which may make early correct diagnosis difficult. Failure to make an early correct diagnosis may have catastrophic consequences on joint range of motion in the chronic stage. The goal of this paper is to describe our three-step approach to the treatment of acute Monteggia lesions based on the stability and radiological appearance of the fracture dislocation, to give an overview of possible pitfalls and clinical and radiological signs that aid the diagnostic process. Methods: Retrospective analysis of 23 patients treated for this type of injury at our Department over a period of 6 years was performed. Treatment options were 1. Closed reduction under image intensifier followed by immobilization in over the elbow cast, 2. Open reduction and intramedullary nailing with ESIN, or 3. Open reduction and plate osteosynthesis. Average follow-up was 37 months. In our Department we aim for definitive treatment of fracture-dislocations in children within the acute setting. In the 23 acute cases, the selected procedure-reduction + casting/reduction + ESIN/reduction + plating-was performed within 2 to 16 h of arrival. 10 patients were treated with reduction + casting, 10 with reduction + ESIN and 3 with reduction + plating. Results: 21 patients were available for long-term follow-up. No nerve or tendon injuries or infections were observed in these cases. By managing the patients with the Three Step Method retaining the reduction was successful in all but one of our acute cases in the study period. Excellent range of motion was observed in all three groups. Conclusions: The Three Step Method allows for primary definitive treatment of these lesions with low complication rates and good range of motion result. Implementing the three step method in the acute phase helps avoid catastrophic consequences on joint range of motion in the chronic stage.

show abstract

The Treatment of Upper Limb Fractures in Children and Adolescents

Cited by 30 publications

References 149 publications

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?

The Three Step Approach to the management of acute pediatric Monteggia lesions

Contact Info

Product

Resources

About