Fractures of the distal humeral metaphyseal-diaphyseal junction in children

BACKGROUND: To our knowledge, there is no report in the English-language literature of metaphyseal-diaphyseal junction fractures of the distal humerus in children. The purpose of this study was to review our experience with this uncommon fracture. METHODS: Between 1998 and 2004, 422 displaced supracondylar humerus fractures underwent operative reduction and fixation at our institution. A retrospective review of medical records and radiographs revealed that 14 (3.3%) of these fractures occurred at the metaphyseal-diaphyseal junction just proximal to the olecranon fossa. In 8 patients, the fracture line was oblique (group A), and in 6 patients, the fracture line was transverse (group B). RESULTS: Average age at the time of fracture was 4.9 years (range, 1.5-10 years). All patients were treated by closed reduction and Kirschner wire fixation and had at least 1-year follow-up. In group A, operative time for reduction and fixation was significantly increased in comparison to the 408 remaining supracondylar humerus fractures. However, the clinical course in group A was uncomplicated, and no loss of fixation at follow-up was noted. The operative time in group B was even longer. These fractures were more problematic as loss of fixation occurred in 5 of the 6 patients, 4 occurring in the sagittal plane. In addition, multiple complications arose in group B including reoperation, cubitus varus, pin migration, and prolonged loss of motion. CONCLUSION: Metaphyseal-diaphyseal junction fractures of the distal humerus in children are rare but can be problematic. The transverse fracture pattern requires additional attention in the operating room with optimal pin fixation. Close postoperative follow-up is necessary. The oblique fracture pattern, while requiring increased time in the operating room for reduction and fixation, is typically stable with the usual fixation used for supracondylar humerus fractures. In summary, metaphyseal-diaphyseal junction fractures of the distal humerus are uncommon elbow fractures in children that should be differentiated from the more common supracondylar humerus fracture for optimal outcomes. LEVEL OF EVIDENCE: Therapeutic level 4 (case series).     

Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization

Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction. A wide array of treatment options exists for the variation in fracture patterns observed. Inherently stable fractures do not require surgical treatment; all other fractures should be considered for additional stabilization. In general, of the many combinations of internal fixation possible, Kirschner wires and screw-and-plate fixation predominate. Early closed reduction typically is successful for unicondylar fractures of the head of the proximal phalanx. Bicondylar proximal phalanx fractures usually are treated with plate fixation. Transverse and short oblique proximal phalanx fractures generally are treated with Kirschner wires, although a stable short oblique transverse shaft fracture can be managed with an intrinsic plus splint. Plate fixation is used in comminuted proximal phalanx as well as comminuted metacarpal fractures, and lag screws in spiral long oblique phalanx shaft fractures and metacarpal head fractures. Kirschner wire fixation is successful in metacarpal neck fractures as well as both short and long transverse oblique shaft fractures.     

外侧微型钢板及克氏针辅助固定治疗儿童肱骨远端骨干-干骺端交界性骨折

目的:探讨外侧微型钢板及克氏针辅助固定治疗儿童肱骨远端骨干-干骺端交界性骨折的手术方法及临床疗效。方法:回顾性分析自2015年1月至2018年12月收治的21例肱骨远端骨干-干骺端交界性骨折患儿,男12例,女9例;年龄2～10岁,平均4.5岁;受伤至手术时间6 h～7 d。影像学资料显示骨折线位于肱骨远端骨干-干骺端交界区域,斜形骨折10例,横形骨折8例,粉碎骨折3例。手术方式均采用切开复位外侧微型钢板及克氏针辅助内固定,采用改良Flynn肘关节评分标准进行临床疗效评价。结果:21例患儿均得到随访,时间8～24个月,平均13个月,愈合时间为6～8周,平均7.2周,术后均未出现骨折再移位、肘内翻畸形及尺神经损伤等并发症。按照改良Flynn肘关节评分标准进行评价,优19例,良2例。结论:儿童肱骨远端骨干-干骺端交界性骨折与肱骨髁上骨折治疗方法不同,采用切开复位外侧微型钢板及克氏针辅助固定治疗具有稳定性强、功能良好、并发症少的优点值得临床推广。     

闭合复位经皮克氏针交叉固定治疗儿童GartlandⅡ型肱骨髁上骨折

目的探讨闭合复位经皮克氏针交叉固定治疗儿童GartlandⅡ型肱骨髁上骨折的临床疗效。方法回顾性分析我科自2015年7月至2018年5月收治的36例儿童肱骨髁上骨折的病例资料,按照Gartland分型均为Ⅱ型骨折,其中ⅡA型16例,ⅡB型20例,均为闭合性骨折;男19例,女17例;平均年龄5.8(3~12)岁。所有病例均行闭合复位经皮内外侧交叉克氏针固定,术后长臂管型石膏固定3周,拆除石膏后进行肘关节屈伸功能锻炼。术后采用Flynn肘关节评分标准评定临床疗效。结果手术时间平均32(20~45)min。本组36例患儿无一例出现医源性尺神经损伤、Volkmann挛缩或肘内翻畸形,其中1例出现针道轻度感染,拔出克氏针后口服头孢类抗生素后痊愈。平均随访13.2(12~24)个月,末次随访按照Flynn临床功能评定标准评定临床疗效:优29例,良6例,可1例,优良率97.2%。结论闭合复位经皮内外侧交叉克氏针固定是治疗GartlandⅡ型儿童肱骨髁上骨折的有效方法,早期复位固定可有效减少单纯石膏固定引起的骨折移位、肘内翻畸形等并发症的发生,有利于肘关节的功能恢复。     

经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折

目的：观察经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法：自2007年6月至2008年12月,采用经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折27例。男18例,女9例;年龄6～12岁,平均8.1岁。伸直型15例,屈曲型12例;尺偏型14例,桡偏型13例。伤后就诊时间0.5～8d,平均3.6d。结果：27例均获随访,时间6～24个月,平均13.5个月。所有骨折均于术后4～6周愈合,平均愈合时间4.5周。未出现内固定物松动和骨折再移位,无Volkmarm挛缩、针眼或深部感染、尺神经损伤、骨化性肌炎等并发症。术后发生肘内翻畸形2例,但内翻角均不超过15°,可能为过早拆除外固定和不适当功能锻炼所致。按Flynn标准评定,结果优19例,良5例,可2例,差1例。结论：C形臂X线机透视下闭合复位经皮克氏针内固定治疗儿童不稳定肱骨髁上骨折手术创伤小,固定可靠,可以获得良好的肘关节功能和外形。     

Stabilization of comminuted fractures of the distal inch of the radius: percutaneous pinning.

Comminuted fractures of the distal inch of the radius have always been difficult to stabilize. Closed reduction and plaster cast fixation frequently result in recurring deformity and some loss of wrist function. A method of closed pinning with proper placement of multiple small Kirschner wires to supplement plaster cast fixation in selected comminuted fractures helps retain anatomical position of the major fragments of the distal end of the radius. This method is sound in principle and we recommend its use in the treatment of severly comminuted fractures of the distal end of the radius.     

闭合复位结合经鹰嘴旁克氏针内固定治疗小儿肱骨髁上骨折疗效观察

目的 探讨儿童肱骨髁上骨折闭合复位后,其内侧采用经鹰嘴旁入路穿针内固定方法的临床疗效.方法 对2015年9月-2018年6月收治的20例肱骨髁上骨折患儿均采用闭合复位结合交叉克氏针固定,其中肱骨内侧采用经鹰嘴旁的经皮克氏针内固定方式.评定其内固定治疗术后肘关节活动功能的效果.结果 术后18例患儿获得了6～12个月随访,...     

Percutaneous pin fixation of intercondylar fractures in young children

T-condylar fractures of the distal humerus are very rare in children. When they do occur they tend to affect those approaching skeletal maturity. Most agree that the undisplaced fracture can be managed conservatively. With increasing displacement and comminution the opinions tend to differ. As an alternative to open reduction and internal fixation we report the use of closed reduction and percutaneous pin fixation for displaced and comminuted T-condylar fractures in a series of three young children. In addition to the classical medial and lateral column fixation we report the use of a transcondylar wire to stabilise the distal fragments and discuss the use of intra-operative arthrography in low supracondylar fractures to exclude a missed intercondylar extension on plain xrays. Although small this series represents the largest series of children less than eight years of age.     

Treatment of ipsilateral supracondylar and forearm fractures in children.

The treatment of ipsilateral supracondylar fractures of the humerus and fractures of the forearm bones was evaluated in 11 children. After an average of 6 years, 10 children had excellent or good results and one had a poor result from Volkmann's ischaemic contracture. Displaced supracondylar fractures of the humerus associated with distal fractures of the forearm bones are best treated by closed reduction and percutaneous pin fixation of the humeral fracture and a below-elbow plaster backslab.     

Treatment of physeal fractures in children]

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.     

儿童严重型肱骨髁上骨折的手术治疗

目的 探讨儿童严重型肱骨髁上骨折的手术治疗及其疗效评价. 方法 回顾性分析2001年6月至2006年6月手术治疗的316例儿童严重型肱骨髁上骨折,男215例,女101例,年龄1～14岁,平均7岁.左侧167例,右侧149例.全部采用切开复位克氏针内固定,术后石膏固定,2～4周后进行功能训练. 结果 随访316例,随访时间6个月～5年,平均2年10个月.按Flynn标准对术后肘关节功能恢复情况进行评价:优253例,良34例,可25例,差4例,优良率90.8%.发生肘内翻27例. 结论 儿童严重型肱骨髁上骨折手法复位失败、开放性骨折、神经血管损伤及影响肘关节功能等严重病例应采用手术治疗,解剖复位骨折断端、克氏针内固定,术后早期进行肘关节功能锻炼,对于提高手术治疗效果、防止或减少肘内翻畸形等并发症的发生有重要意义.     

桡骨远端不稳定骨折3种治疗方法疗效比较

目的探讨不同方法治疗桡骨远端不稳定骨折的临床疗效。方法对桡骨远端不稳定骨折92例（97侧）分别采用3种治疗方法：手法复位结合小夹板（或树脂夹板）或石膏外固定（A组）、克氏针有限内固定结合石膏外固定（B组）、锁定接骨板内固定或辅以石膏短期外固定（C组）。对3种方法的疗效进行比较。结果 92例均获随访,时间6～21个月。3种治疗方式的优良率为：A组88.6%,B组89.6%,C组85.7%。3组疗效比较差异无统计学意义（P〉0.05）。结论 3种治疗方法均操作简单,复位满意,固定可靠,并可进行早期功能锻炼,均是治疗桡骨远端不稳定骨折的有效方法。     

Supracondylar fractures of the humerus in children: analysis of the results in 142 patients

One hundred forty-two children who had supracondylar humerus fractures and who were treated either by open reduction and internal fixation or by closed methods were reviewed. There were 104 boys and 38 girls. Their ages ranged between 2 and 14 years, with an average age of 8 years. One hundred thirteen of the fractures were of the extension type and 29 were of the flexion type. Sixty-two patients were treated by manipulative reduction and immobilization in a plaster of Paris cast, and 20 were treated by overhead skeletal traction followed by the application of a plaster of Paris cast. The other 60 patients were treated by open reduction and internal fixation. The follow-up period ranged from 4 years to 11 years, with an average of 7.5 years. The results were evaluated based on the range of motion, the subsequent deformity, if any, and the carrying angle. In the overall series we had 72 (50.70%) excellent, 31 (21.83%) good, 13 (9.15%) fair, and 26 (18.30%) poor results.     

结合关节造影、单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的疗效观察

目的探讨关节造影下单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的手术技巧及疗效。 方法回顾性分析2017年1月至2020年1月期间中山市中医院收治的43例肱骨远端全骨骺分离骨折患儿的临床病历资料，其中男32例、女11例；年龄1.5 ~ 4.2个月，平均2.8个月。伸直尺偏型37例，伸直桡偏型6例；高处坠落伤18例，运动中摔伤25例。受伤至手术时间为12 ~ 34 h，平均20.5 h。均可采用关节造影、单人操作完成闭合复位，助手经皮克氏针内固定术，术后石膏托外固定。术后3、6、9个月时采用Flynn肘关节临床功能评分标准评定疗效。 结果本组手术时间（32.8±10.6）min，术中透视次数（10.5±3.2）次。平均住院时间4 d（3 ~ 7 d）。43例均获得随访，平均随访时间18.4个月（9 ~ 36个月）。术后3 ~ 4周，X线片显示骨折临床愈合后，拆除石膏并拔除克氏针。按照Flynn肘关节临床功能评分标准评定疗效：术后3个月优良率为81.4％（35/43），术后6个月优良率为88.3％（38/43），术后9个月优良率为88.3％（38/43）。术后患儿均未出现骨筋膜室综合征、血管神经损伤、皮肤坏死、钉道感染等并发症。 结论术中肘关节造影可清晰地显示肱骨远端软骨，指导单人闭合复位微创治疗肱骨远端全骨骺分离骨折，直观判断复位后效果，指导经皮穿入克氏针，取得满意的治疗效果，本方法操作相对简单，易于掌握，疗效确切，有利于肘关节功能早期恢复，值得推广。     

不同类型儿童肱骨髁上骨折的治疗探讨

目的探讨不同类型儿童肱骨髁上骨折的治疗方法。方法对GartlandⅠ型骨折,单纯应用石膏外固定;GartlandⅡ型和Ⅲ型骨折,选择闭合复位、经皮穿针内固定;对于闭合复位、经皮穿针失败或伴有明显血管、神经损伤症状以及患肢肿胀特别严重的病例,采用切开复位克氏针内固定。结果未出现骨筋膜室综合征、血管或神经受损等并发症。术前合并神经损伤的病例,其神经功能得以完全恢复。56例随访16~28个月,平均20.6月,按F lynn功能评价标准,优38例,良16例,可1例,差1例。结论针对不同类型儿童肱骨髁上骨折采取相应的治疗方法,疗效满意。     

Treatment of displaced supracondylar fractures of the humerus in children at the orthopaedic ward of the Children's Hospital in Kielce]

Ninety five children in age from 4 to 12 years (61 boys and 34 girls) with displaced supracondylar distal humerus fractures were treated at the orthopaedic ward of The Children's Hospital in Kielce between I 2000-XII 2001. The method of choice was closed reduction and percutaneous fixation with Kirschner wires (74 children). We also used closed reduction and application of an above elbow cast (12 children), skeletal traction with fixation after swelling resignation (5 children), and open reduction and internal fixation (4 children). In 90 cases we did not observe any neurovascular disorders, and early functional results were good or satisfactory. 2 cases were associated with transient, postreduction radial nerve palsy. In 2 children surgical intervention was necessary due to external compression of the brachial artery in one case, and contusion with brachial artery spasm in another. In one girl we observed development of Volkmann's contracture (treated surgically with good functional result). The authors conclude that the closed reduction and percutaneous K-wire fixation can be used as a treatment of choice for displaced supracondylar fractures of the humerus in children.     

闭合复位克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的探讨闭合复位内外侧3针交叉固定治疗GartlandⅢ型儿童肱骨髁上骨折的疗效。方法对195例GartlandⅢ型儿童肱骨髁上骨折患者行闭合复位后,C臂机监视下先在肱骨髁外侧用2枚克氏针平行或交叉固定,再伸直肘关节到50°,保护尺神经下用1枚克氏针在内侧交叉固定,术后长臂石膏托固定于肘关节伸直70°制动3周。结果 195例均获随访,时间5~35个月。出现医源性尺神经损伤2例,肘内翻畸形需截骨矫形1例,肘部前侧局限性骨化4例。按Flynn标准评定疗效:优180例,良8例,一般6例,差1例,优良率为96.4%。结论闭合复位内外侧3针交叉固定治疗GartlandⅢ型儿童肱骨髁上骨折可有效减少医源性尺神经损伤,降低肘内翻畸形发生率,疗效满意。     

闭合复位经皮克氏针固定治疗儿童肱骨髁上骨折

目的总结闭合复位经皮克氏针固定治疗儿童肱骨髁上骨折的疗效。方法18例儿童肱骨髁上骨折,均属GartlandⅢ型,均行闭合复位经皮克氏针固定。结果平均随访6(3~12)个月,所有骨折术后平均8.8(6~12)周愈合。参照F lynn临床功能评定标准:优13例,良2例,一般3例,优良率为83.3%。结论闭合复位经皮克氏针固定治疗儿童肱骨髁上骨折,是一种安全、简便、损伤小、固定可靠、有效的方法。     

Fractures of the distal radius. Current concepts for treatment

The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.     

Olecranon fractures: treatment options

Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion. Open reduction and internal fixation is the standard treatment for displaced intra-articular fractures. Stable internal fixation with figure-of-eight tension-band wire fixation for simple transverse fractures allows early motion to minimize stiffness. Use of two knots produces symmetric tension at the fracture site and provides more rigid fixation than a single knot. Care should be taken to ensure that the tension-band wire and the proximal ends of the Kirschner wires are positioned deep to the triceps fibers to prevent wire migration. If the anterior cortex is engaged, overpenetration of the wires into the soft tissues should be avoided. Plate fixation is appropriate for severely comminuted fractures, distal fractures involving the coronoid process, oblique fractures distal to the midpoint of the trochlear notch, Monteggia fracture-dislocations of the elbow, and nonunions. For comminuted fractures and nonunions, a dorsally applied limited-contact dynamic-compression plate with supplemental bone graft should be utilized to support comminuted depressed articular fragments. A one-third tubular hook-plate can be used for fractures with a small proximal fragment for which additional fixation of the olecranon tip is desired. Fragment excision and triceps advancement is appropriate in selected cases in which open reduction seems unlikely to be successful, such as in osteoporotic elderly patients with severely comminuted fractures.