Changes in the management of pediatric medial humeral epicondyle fractures with and without associated elbow dislocation
| Autor: | Markus Dietzel, Simon Scherer, Hans Joachim Kirschner, Justus Lieber, Jörg Fuchs, Ilias Tsiflikas, Nicole Jordan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Humeral Fractures medicine.medical_treatment Elbow Joint Dislocations 03 medical and health sciences Fracture Fixation Internal 0302 clinical medicine Elbow Joint medicine Humans Kirschner wire Range of Motion Articular Child Reduction (orthopedic surgery) General Environmental Science Fixation (histology) Retrospective Studies 030222 orthopedics Osteosynthesis business.industry 030208 emergency & critical care medicine Humerus medicine.disease Surgery Pseudarthrosis medicine.anatomical_structure Treatment Outcome Elbow dislocation General Earth and Planetary Sciences Epicondyle business |
| Zdroj: | Injury. 52(8) |
| ISSN: | 1879-0267 |
| Popis: | Purpose The optimal management of medial humeral epicondyle fractures continues to be debated since decades. This single center study analyzes changes and optimizations of treatment over an observation period of 16 years and reports the results. Materials and Methods Retrospective analysis of all patients treated with a medial humeral epicondyle fracture between 2005 and 2020 at our institution. Results Ninety-six patients (mean 9.3 years, range 1 - 15) were included in the study. In 25 cases (26 %), the fracture was associated with an elbow dislocation. Most patients received surgical treatment (83.3 %), whereas 17.7 % were treated nonoperatively. Surgical treatment consisted of open reduction and fixation with compression screw (n = 44 steel, n = 2 absorbable), K-wire (n = 30), a combination of screw/K-wire (n = 2), or a PDS suture (n = 1). Compression screws have been used significantly more often in the latter half of the study period (p = 0.006). Patients were immobilized in a long arm cast for 29 days (range 11 – 50). Eleven surgically treated patients were early mobilized in an elbow orthosis. After a mean follow up of 7.6 months [ 2 – 61), Mayo elbow performance index (MEPI) outcome was excellent in all 96 patients. Loss of elbow movement (LOM) was found to be mild in 30 and moderate in 15 patients. LOM was found to be associated with surgical treatment (p = 0.001), and with concomitant elbow dislocations (p = 0.29). One pseudarthrosis occurred after conservative treatment. A persistence of ulnar nerve palsy or recurrent joint instability has not been described. Conclusion Most children with medial humeral epicondyle fractures nowadays undergo surgery. Screw osteosynthesis represents the increasingly preferred method in order to prevent joint instability or non-union, and to allow shorter immobilization duration. Overall results after medial epicondyle fractures are good. |
| Databáze: | OpenAIRE |
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