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PubMedDate not supplied

Fracture separation of the distal humeral epiphysis in children younger than three years old.

This study evaluated the change of carrying angle and the causes of cubitus varus after the fracture separation of the distal humeral epiphysis in young children. Twelve cases of fracture separation of distal humeral epiphysis were treated from January 1995 to July 1997. The age of all patients was younger than 3 years old. A metaphyseal fragment was seen in all cases (Salter-Harris type II), but the size of the metaphyseal fragment was either a very small flake or a large Thurston-Holland fragment. Posteromedial displacement was seen in all cases. There were three treatment groups: closed reduction with percutaneous pinning, closed reduction with cast, and cast without reduction. Follow-up period averaged 23.5 months (range, 12-40). Cubitus varus deformity was seen in seven cases, and six of them had a partial defect of the medial condyle that was avascular necrosis. The methods of treatment, age of injury, and the type of epiphyseal injury had no influence on the development of cubitus varus, but avascular necrosis of the medial condyle was related to the cubitus varus deformity (p<0.05). The results of this study suggest that fracture separation of distal humeral epiphysis in young children is likely to produce cubitus varus deformity with the development of avascular necrosis of the medial humeral condyle.

Casts, Surgical↗
PubMed2002

Elbow flexion response as another primitive reflex.

In daily clinical practice we noticed that patients with intellectual impairment spontaneously flex the elbow within a few seconds of the forearm being manipulated during routine examination of spasticity of the muscles in the upper extremities. We termed this phenomenon elbow flexion response (EFR), and prospectively studied it in 229 patients who underwent in-hospital rehabilitation following brain damage. Evaluation of each patient included EFR, patient profile, ability to communicate, scores on three parameters from various intelligence tests, scores on seven parameters testing primitive reflexes, and scores on three parameters describing personality. We investigated for relationships among these parameters. Consequently, although EFR rarely have a statistical association with the varied profiles of patients, patients with bilateral lesion or bilateral paresis demonstrated significantly more marked EFR than those with unilateral lesion or unilateral paresis. Patients with involvement of the frontal lobe showed significantly more marked EFR than those without damage in this area. Elbow flexion responses occurred significantly more frequently in relation with lower scores on intelligence and occurred with significantly higher frequency in conjunction with the more marked appearance of conventional primitive reflexes. Therefore, we conclude that EFR have a strong association with intelligence and with the existence of frontal lobe lesion, and their mode of clinical presentation parallels that of primitive reflexes particularly that of the grasp reflex. We propose that EFR could be referred as a variation of the grasp reflex occurring in the more proximal or axial part of the body.

Brain Injuries↗
PubMedDate not supplied

The surgical treatment of osteochondritis of the capitellum.

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.

Adolescent↗
PubMed1990

Completely displaced supracondylar fracture of the humerus in children. A review of 1708 comparable cases.

The displaced supracondylar fracture of the humerus in children is a very difficult injury to treat. Manipulation and splint immobilization is perhaps the most common method. A review of the literature on 1708 comparable cases revealed that several different treatments were used. The worst results occurred with manipulation and splint immobilization alone. The best results occurred with traction techniques and well-performed Kirschner-pin transfixation, either open or closed. Complications such as Volkmann's ischemic contracture and myositis ossificans are rare. A completely displaced supracondylar fracture in a child should not be treated by manipulation and splint immobilization alone.

Bone Wires↗
PubMed1996

Chronic Monteggia lesions in children. Complications and results of reconstruction.

We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.

Age Factors↗
PubMed1986

[Injuries of the distal epiphysis of the humerus in the period of growth].

From 1978 to 1983 in the Orthopedic University Clinic (Oskar-Helene-Heim, Berlin) 75 children with fractures of the distal humerus received medical treatment. The results of 25 intra-articular fractures of the distal humerus in children (ten fractures of the radial condyles, eight fractures of the ulnar epicondyles, three Y-fractures of the condyles, two luxations with additional flake fractures, one fracture of the ulnar condyle) will be reported. The frequency of remaining complications like valgus and varus deformities, pseudarthroses, posttraumatic osteochondroses and "fish tail" deformities are described. The possible mechanism of such developing deformities is discussed. The resulting consequences for the surgical treatment in the future are also discussed.

Adolescent↗
PubMed1992

[Distal intra-articular humerus fractures in adults. Results of surgical treatment].

Intra-articular fractures of the distal end of the humerus are severe injuries because stable anatomic reduction is difficult to achieve even operatively. They are often accompanied by nerve lesions and often lead to heterotopic para-articular ossifications. Functional recovery is only rarely complete. Follow-up of 54 cases of operatively treated fractures of this kind showed 56% excellent and good late results. In immediate operations we observed fewer infections, less ossification, and better functional results than after delayed operative treatment. We therefore recommend careful examination for nervous deficits, immediate stable internal fixation of the fractures displaying the ulnar nerve, and handling the soft tissue as gently as possible to avoid additional damage. Postoperative physiotherapy should also be started immediately.

Elbow Joint↗
PubMed1989

[Surgical treatment of distal humerus fractures in children].

From 1955 to 1987 414 children with supracondylar fractures of the humerus were treated at the surgical department of the University of Erlangen. Most important for the choice of treatment in supracondylar fractures was the classification of Baumann. 33 children concerning stage I were treated with cuff and collar or cast. Out of 381 patients with stage II and III Baumann's extension was used in 352 children; 29 had to be operated. The operation was indicated in a further 56 children. 20 of these had a lesion of the condylus radialis, 18 of the epicondylus ulnaris, 8 children showed diacondylar, 3 transcondylar lesions, 3 children had injuries of the condylus ulnaris and 4 more children showed splintered fractures. In 234 patients a follow-up was carried out according to the scheme of Morger. In 91% there was an ideal or good late result, in only 2% of the patients the result was unsatisfactory. The majority of distal fractures of the humerus can be treated conservatively with good results; operative treatment does not improve the functional and cosmetic results. It is indicated in complicated forms of fracture, in which satisfying results are not to be expected by conservative treatment.

Child↗
PubMed1990

[Isolated dislocation in the distal radio-ulnar joint].

Anatomy, injury-mechanism and classification will be illustrated with a casuistry of the rate isolated luxation of the ulnar head. Diagnosis is established clinically and with comparative X-rays. In our case the luxation was irresponsible in general anaesthesia and had to be succeeded by open reposition with temporary pin-fixation. Postoperatively a cast up to the upper arm is necessary for six weeks. With the removal of the plaster the wire pins also must be immediately withdrawn, as to evade complications like fatigue-breakage of the implanted material. With adherence to this therapeutic scheme operative treatment is not problematic and - by means of posttraumatic physical therapy - shows a good functional result.

Bone Nails↗
PubMed1984

Posterior interosseous neuropathies: natural history.

Fifteen patients with unilateral posterior interosseous neuropathies were observed and 12 were followed for five years. Seven patients had had closed injuries to the elbow and eight had had spontaneous onset associated with heavy tennis or racquetball activity. All had electrodiagnostic abnormalities consistent with a posterior interosseous neuropathy. All injuries responded to conservative therapy and resolved with time.

Adolescent↗
PubMed1990

Radial head subluxation: epidemiology and treatment of 87 episodes.

Radial head subluxation is a frequent upper-extremity injury in children. Through a prospective study of patients seen in the emergency department, the epidemiology and treatment were reviewed, and two methods of reduction were compared. During a nine-month period, there were 87 episodes of radial head subluxation in 83 children with six cases in infants 6 months old or younger. A pull mechanism of injury was not identified in 49% of the cases. Girls were seen more often than boys, the left arm was more frequently involved, and the incidence of recurrence was 26.7%. The two reduction methods did not differ significantly in their initial success rate. The presence of a click during a reduction attempt had a positive predictive value of 92% and a negative predictive value of 76%. Most children (76.8%) had return of arm use in less than ten minutes. Slow return of arm use (more than ten minutes) was not associated with delay in reduction but was associated with age of less than 2 years (P less than .001).

Chi-Square Distribution↗
PubMed1988

[Monteggia injuries].

Sixty-three recent Monteggia lesions are reported, which were all treated operatively. In 52 patients, the ulna was stabilized by a compression plate. Dislocation of the radial head was reduced by a closed procedure in 24 patients and 38 patients an open operation was performed (including fractures, sutures of the annular ligament, and resections of the radial head). After 38 months, the results were better in comparison to series using conservative or medullary pinning (88% good and very good). Poor results must be expected if the operation is delayed for 2 or more weeks, if the radial head has to be resected, or in posterior Monteggia lesions. The late reconstruction of a neglected Monteggia lesion by means of an osteotomy of the ulna shaft and plate fixation is described in a child.

Adolescent↗
PubMed2001

Deformity after fracture of the lateral humeral condyle in children.

We studied 28 displaced (Jacob types II and III) fractures of the lateral humeral condyle in 28 children. There were only two Milch type I fractures. Twenty-one fractures were treated by open reduction and internal fixation with K-wires, Palmer nails, or sutures. Seven patients were treated with a plaster cast, five following closed reduction, and the primary displaced position being accepted in two. Anatomic reduction was obtained in 18 patients. All but one fracture were united at review 2 years to 16 years later. The distal humerus was wider on the injured side in all patients. Six patients had a visible varus deformity, and three patients had a visible valgus deformity. The radiologic tilt of the joint surface and the depth of the trochlear groove were measured in patients more than 10 years old at review. All patients with a final varus tilt of the joint surface on the injured side were less than 9 years of age at injury, and all but one of the patients with Milch type II fractures had a deepening of the trochlear groove. Two patients developed avascular necrosis of the trochlea. One of these had a concomitant fracture of the medial humeral epicondyle, and the other suffered a lateral condylar fracture preceded by a supracondylar fracture. We conclude that a reduced growth potential at the trochlear groove is a regular complication of the Milch type II fracture, and that the Jacobs classification is the most useful in the assessment of the method of treatment.

Adolescent↗
PubMed1993

Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on outcome.

Although severe intra-articular fractures of the distal radius are often treated with external fixation/distraction, little attention has been devoted to the amount and duration of fixator distraction required to maximize outcome. To determine these effects, we conducted a retrospective study of 26 patients whose primary treatment was external fixation/distraction. Patients were evaluated by chart review, questionnaire, x-ray films, and physical examination an average of 104 weeks after injury. The carpal height index was used to quantify distraction. Scores for pain, function, wrist motion, and grip strength and the total score were adversely affected in proportion to the increase in carpal height index by distraction. Outcome was adversely affected as the duration of distraction increased. Motion scores were affected most. Overall, patients recovered at least 75% of motion and grip strength, and 85% attained New York Orthopedic Hospital grades of good or excellent. These are the first data to show that there are potential adverse effects from increasing amounts of distraction and prolonged use of the external fixator.

Adult↗
PubMed1998

Displaced fractures of the radial neck in children: long-term results and prognosis of conservative treatment.

Fractures of the radial head or neck in children may lead to radial head deformity and loss of pronation and supination. Trauma may not only be caused by the injury itself, but also may occur secondarily to surgical reduction and manipulation of fracture fragments. Thirty-eight children with displaced radial neck fractures were investigated 2 to 20 years after the initial accident. Whereas radial head deformity was present in 83% of cases, functional disorder was found in only four children (11%). These children had either developed secondary growth disturbances, which had led to a radioulnar synostosis in one case, or they had been treated by open surgical reduction. On follow-up radiographs, all conservatively treated fractures with angulation up to 50 degrees had corrected themselves spontaneously. The high complication rate after open reduction and the poor functional results and inconvenience for the pediatric patient makes conservative treatment of radial neck fractures in children preferable.

Adolescent↗
PubMed2001

Long-term results of treatment of fractures of the medial humeral epicondyle in children.

BACKGROUND: The treatment of isolated, displaced fractures of the medial humeral epicondyle in children is controversial. Both plaster cast immobilization without reduction and open reduction and internal fixation have been advocated. The purpose of this long-term retrospective study was to analyze the functional and radiographic results of both nonsurgical and surgical management of these injuries. METHODS: Forty-two patients who had had an isolated fracture of the medial humeral epicondyle with displacement of >5 mm at an average age of twelve years (range, eight to fifteen years) were evaluated at an average age of forty-five years (range, thirty to sixty-one years). The patients were divided into three groups that were comparable with regard to the amount of fracture displacement, age at the time of the fracture, age at the time of follow-up, sports activities and occupation, and duration of follow-up. In Group I (nineteen patients), the fracture had been treated with a long-arm plaster cast without reduction of the displaced medial epicondyle. In Group II (seventeen patients), open reduction and internal fixation with either Kirschner wires or a T-nail had been performed. In Group III (six patients), the epicondylar fragment had been excised with suture reattachment of the tendons and the medial collateral ligament. RESULTS: According to a functional grading scale, there were sixteen good and three fair results in Group I. All but two patients were seen to have nonunion of the fragment on follow-up radiographs, but all had a normal result on valgus stress-testing of the elbow. The range of motion of the elbow was either normal or minimally decreased, and the grip strength of the ipsilateral hand was normal. There were fifteen good and two fair results in Group II. All patients had union of the medial epicondyle, with various radiographic deformities of the medial epicondyle, but the functional results were similar to those of the Group-I patients. The Group-III patients had four poor and two fair results. Four had constant pain at the elbow and paresthesias in the distribution of the ulnar nerve. One patient had a restricted range of motion of the elbow, four patients had an unstable elbow, and three patients had decreased grip strength of the ipsilateral hand. CONCLUSIONS: In our study, nonsurgical treatment of isolated fractures of the medial humeral epicondyle with between 5 and 15 mm of displacement yielded good long-term results similar to those obtained with open reduction and internal fixation. The nonunion of the epicondylar fragment that was present in most patients who had been treated only with a cast did not adversely affect the functional results. Surgical excision of the medial epicondylar fragment should be avoided because the long-term results are poor.

Adolescent↗
PubMedDate not supplied

Supracondylar fractures: posterolateral type with brachialis muscle penetration and neurovascular injury.

Twenty-seven children with vascular deficit associated with the displaced posterolateral type of supracondylar fracture were explored surgically. Twenty-two children had median nerve signs. Associated clinical findings were bruising, tethering or puckering of the skin in the antecubital region, and a palpable subcutaneous medial spike of the proximal humeral fragment, indicating that the brachialis muscle was penetrated. Manipulation was avoided in such cases. At exploration, the neurovascular bundle was found trapped anterior to the fracture edge in 18 cases, dislocated behind the fracture edge in five cases, and separated by the spike in four cases. Fasciotomy of the antecubital region was performed, and the neurovascular bundle was released from entrapment. The vessel pulsated after release in 21 cases, vascular procedures were done in four, and the vessel ends were ligated in two completely lacerated vessels. Manipulation should be avoided in displaced posterolateral supracondylar fractures with neurovascular deficit when there is clinical evidence that the brachialis muscle belly has been buttonholed.

Accidental Falls↗