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PubMed2006

The anterior cubital approach for displaced pediatric supracondylar humeral fractures.

The authors report a technique of the anterior cubital approach that is an exposure for displaced pediatric supracondylar fractures. Reduction is very safe and easy with this approach. Anatomical structures that hinder reduction such as the brachialis muscle or joint capsule and neurovascular tissues can be identified easily. This technique has not been a popular form of treatment in many countries, particularly in the United States.

Bone Wires↗
PubMed1997

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Accidental Falls↗
PubMedDate not supplied

[Osteosynthesis with Kirschner wires in the treatment of dislocated supracondylar humeral fractures in children].

INTRODUCTION: Elbow fractures account for 7-9% of all fractures in childhood, while the supracondylar type is the most common (up to 70%). 84% of all supracondylar elbow fractures occur under the age of 10 years (most often between the age of 5 and 8). The aim of this study was to present the technique and results of treatment of supracondylar fractures with grade III fragment dislocation in pediatric population. Treatment included orthopedic repositioning and percutaneous pin fixation. MATERIAL AND METHODS: Over the period 1991-2000, 255 patients were hospitalized due to supracondylar fracture of the humerus with grade III fragment dislocation at the Pediatric Surgery Clinic in Novi Sad. All patients were aged 3-15 years. Orthopedic repositioning and percutaneous pin fixation under X-ray control was performed in 243 patients (95.29%). RESULTS: This study included 167 (65.5%) patients with full documentation. Extensor type of fracture was verified in 151 patients (90.42%). Male patients predominated over female patients--119:48. The average follow-up period was 4, 5 months. On the basis of clinical examination, and after completed rehabilitation, satisfactory results were obtained in 158 patients (94.6%), while in 9 patients the final outcome was unsatisfactory. DISCUSSION: Literature analysis points to advantages of orthopedic repositioning and percutaneous pin fixation, with certain modifications in the treatment of supracondylar elbow fractures with grade III dislocation. CONCLUSIONS: Obtained results of treatment, advantages of this procedure, and our experience, suggest that orthopedic repositioning and percutaneous pin fixation is a procedure of choice in treatment of supracondylar elbow fractures with third III dislocation in children.

Adolescent↗
PubMed1990

[Humeral fractures with paralysis of the radial nerve].

Forty fractures of the humerus associated with radial nerve palsy were reviewed after an average follow-up of 11 years. Early exploration of the radial nerve and internal fixation of the fracture was performed in 20 patients, while the other 20 patients were treated by closed reduction and immobilization in a plaster cast. In four patients of the latter group the radial nerve did not recover and a delayed exploration was performed. In each treatment group functional recovery of the radial nerve was observed in 16 patients (80%). On the basis of these results the authors suggest treating fractures of the humerus with radial nerve palsy by closed reduction. If there is no evidence of spontaneous recovery within 3-4 months, an exploration of the radial nerve should be performed.

Adolescent↗
PubMed1990

[Intramedullary nailing with a Rush pin in the treatment of diaphyseal humeral fractures].

The authors discuss their 20 years of experience in the treatment of diaphyseal fractures of the humerus with Rush-type intramedullary nailing. The various operative and nonoperative methods for the treatment of this type of fracture are critically analyzed. The results were excellent in 60.5% of the cases, good in 29.6%, and poor in only 9.9%, in which healing was over 4 months late and a hypotrophic callus was present. The advantages of this treatment are as follows: adequate reduction of the fracture, simplicity of execution, good results, and shorter period of immobilization compared to other methods.

Adolescent↗
PubMed1977

[Treatment of childhood humeral fractures by wire fixation].

Out of 526 upper limb fractures treated in the Pediatric Surgery Department of the Péterfy Sándor Hospital between 1970-1975, 63 patients were operated on. (11.9%). Fractures in childhood are generally treated by closed methods because healing of the growing bone is favourable. If it is reasonable, fractures of the forearm bones are successfully treated by means of intramedullary wire fixation, fractures of the elbow by means of transfixation. No septic complication occured following operation. Growth disturbancies were not observed in the affected bones after the operative intervention in the course of 1 to 5 years. On this ground the author recommends the adaptational "minimal" osteosynthesis in the treatment of fractures in infancy, if closed methods do not promise optimal results.

Accidents, Traffic↗
PubMed1987

[Significance of rotation errors in supracondylar humeral fractures in the child].

To get information about the importance of malrotation for posttraumatic varus or valgus deformity a clinical, radiological and CT follow-up examination of 20 children who were treated for supracondylar fracture from 1983 to 1985 was done. Rotational-displacement was measured on computed tomographical images taken from the region where fracture had happened. On the ap follow-up X-ray from both, the fractured and the other side, and the X-ray which was made after reduction, the medial and lateral colonne were measured from a "special point" in the middle of the shaft of the humerus. The length of the colonnes and their difference were compared. 15 of the 20 patients showed internal malrotation, 1 patient external malrotation and 4 showed no rotational-displacement. In 15 of the 16 patients with malrotation, the rotational-displacement caused a change in the length of the colonnes. Just in one case malrotation caused a minimal deformity of the carrying angle without alteration of the length of the colonnes. 93% of the cases with internal malrotation showed varus deformity. In 3 cases we saw growth disturbance of the epiphyseal plate, but the induced alteration of the length of the colonnes were minimal compared with the changes caused by malrotation.

Child↗
PubMed1988

In vitro comparison of three fixation methods for humeral fracture repair in adult horses.

The stiffness, load to failure, and bending moments of adult intact equine humeri and humeri repaired with 3 fixation techniques were determined in vitro. Bones were tested in axial compression (30 pairs), mediolateral 3-point bending (15 pairs), and caudocranial 3-point bending (15 pairs). An oblique osteotomy of 1 humerus of each pair was performed to simulate the long spiral oblique fractures that occur clinically in horses. Bones were repaired in 3 ways: group 1--nylon band cerclage fixation (20 bones); group 2--multiple intramedullary pinning (20 bones); and group 3--nylon band cerclage fixation and multiple intramedullary pinning (20 bones). Intact bones were significantly (P less than 0.05) stronger than repaired bones in each testing mode. Bones repaired with bands only were significantly less stiff in bending than were bones repaired with pins only or with pins and bands. In compression, only specimens repaired with pins and bands were significantly stiffer than were bones repaired with bands only. Bones repaired with bands only required significantly less load to failure in compression and in caudocranial bending than did bones repaired with pins only or with pins and bands. Bones repaired with pins only deformed through the full displacement of the actuator (5 cm), and pins deformed plastically. Bones repaired with pins and bands were stiffer and had higher bending moments than did bones repaired with pins only, but the differences were not significant.

Animals↗
PubMed1987

Intra-articular distal humeral fractures in adults.

This article describes a technique of open reduction and internal fixation of intra-articular fractures of the distal humerus in adults. The historical treatment of these fractures is surveyed, including current classification systems. Anatomy is reviewed, specifically as it pertains to surgical intervention. The results in 23 consecutive patients stabilized through an intra-articular olecranon osteotomy exposure are reported.

Adolescent↗