Wie l�sst sich die Wachstumsprognose nach kindlicher suprakondyl�rer Humerusfraktur erfassen?

Abstract

Supracondylar fracture of the humerus is the most frequently investigated fracture in children. However, systematic studies about postoperative growth patterns cannot be found in the literature. In this retrospective study, the authors attempt to delineate the configuration of supracondylar fractures which allow spontaneous correction of a malalignment or cause post-traumatic growth disturbances. The study included 256 children with supracondylar fracture of the humerus: 184 of them (71.9%) were available for longterm follow-up. The plain films of these children were reviewed and the Baumann and shaft-capitulum angles recorded. Spontaneous correction of a primarily displaced fracture was found in 13.0% ( n=21) of all fractures in the sagittal plane. Spontaneous correction in the frontal plane could not be shown. Growth disturbance was discovered in 10.5% ( n=16) in the frontal plane. No growth disturbance was demonstrated in the sagittal plane. The relatively small number of growth disturbances can be attributed to the low growth potential of the distal physeal plate of the humerus. Growth disturbances with secondary rotational errors were not observed in this study. Spontaneous corrections of alignment in the sagittal plane are only possible under a certain age. Spontaneous correction in the frontal plane, however, is inadequately assessed with this study. The design of a prospective study was formulated to assess how to improve the therapeutic management of supracondylar fractures and to answer additional open questions. Follow-up radiographs and standardized clinical evaluations have to be performed at the time of first free range of movement and 2 years after the trauma. This study will investigate whether therapeutic progress at follow-up is better evaluated with radiological or clinical means.

Biomechanical comparison of different external fixator configurations for stabilization of supracondylar humerus fractures in children

“…Nonetheless, there are many functional complications resulting from this deformity which also affect the quality of life of the young patients, such as posterolateral instability and constant painful subluxation of the elbow, damage to the function of the ulnar nerve, predisposition to fractures of the radial condyle and to a posterior luxation of the shoulder (Abe et al, 1995;Beuerlein et al, 2004;Davids et al, 1994;O'Driscoll et al, 2001;Ogino et al, 1986;Uchida & Sugioka, 1990). As there exists minimal to no potential of remodeling in the frontal plane, patients have to undergo another operation to correct the deformity (Flynn et al, 1974;Jain et al, 2000;Wessel et al, 2003). The finding that there were no statistically significant differences between the uFES and the rFES in external rotation loading can be explained by the characteristics of the fragments caused by the oblique fracture line of supracondylar extension fractures.…”

Gekreuzte Kirschner-Draht-Osteosynthese der suprakondylären Humerusfraktur bei Kindern

“…Zur operativen Therapie stellen die geschlossene Reposition und perkutane Kirschner-Draht-Osteosynthese mit Oberarmgipsverband ein etabliertes Verfahren dar [1,4,5,7,8,23]. Der Vorteil der gekreuzten Anwendung der Drähte ist die stabilere Versorgung als die Einbringung zweier Drähte nur über den radialen Pfeiler [1].…”

“…Grundsätzlich entscheidend sind die optimale Reposition und stabile Fixierung der Fraktur, da nur sie sehr gute funktionelle und ästhetische Ergebnisse erbringen können. In seltenen Fällen kann es jedoch trotz optimaler Frakturstellung aufgrund von Wachstumsstörungen zu einer Achsenänderung kommen oder, bedingt durch Weichteilschäden, ein Bewegungsdefizit verbleiben[8,23].…”

Distale Humerusfrakturen

“…In den beiden großen Studien zu suprakondylären Humerusfrakturen, in denen insgesamt über 700 Patienten nachuntersucht werden konnten, wurden Ergebnisse mit Achsabweichungen in der Frontalebene im Varus-/Valgusrichtung >5° und Einschränkungen der Beweglichkeit für Flexion/Extension >10° als unbefriedigend eingestuft [32,33].…”