Comparing clinical efficacies among three therapeutic approaches for Delee type-B fracture-separation of distal humeral epiphysiolysis in children

Abstract

Objective To compare the clinical efficacies of closed reduction, closed reduction & internal fixation, limited open reduction & internal fixation for Delee type-B fracture-separation of distal humeral epiphysiolysis in children. Methods The clinical data of 36 children with Delee type-B fracture- eparation of distal humeral epiphysiolysis from January 2008 to June 2015 were retrospectively analyzed.The approaches were closed reduction (n=7), closed reduction & internal fixation (n=11) and open reduction via a limited medial or lateral incision & internal fixation (n=18). In closed reduction group, there were 6 boys and 1 girl with a mean age of 21 months; in closed reduction & internal fixation group, 8 boys and 3 girls with a mean age of 23 months; in limited open reduction group, 12 boys and 6 girls with a mean age of 22.5 months.Three groups were compared with regards to Flynn elbow scoring and carrying angle difference between affected side and contralateral side at 1 year postoperation. Results During a mean follow-up period of 26 (12-60) months, all fractures achieved clinical healing at 4 weeks postoperation.By the Flynn elbow scoring at 1 year postoperation, the good-to-excellent rate was 57.1% (4/7) in closed reduction group, 81.8% (9/11) in closed reduction & internal fixation group and 100% (18/18) in limited open reduction group with significant differences (P<0.05). The carrying angle difference between affected and contralateral sides at 1 year postoperation were 17.40±5.20, 5.60±1.80 and 3.50±0.80 with significant differences (P<0.05). Three cases in closed reduction group and 1 case in closed reduction & internal fixation group required supracondylar osteotomy for elbow varus.No delayed union, compartment syndrome or iatrogenic vascular or nervous lesions occurred in all groups. Conclusions For Delee type-B fracture-separation of distal humeral epiphysiolysis in children, as compared with closed reduction and closed reduction & internal fixation groups, limited open reduction & internal fixation may achieve optimal functional outcomes and has the smallest carrying angle difference between affected and contralateral sides.Limited open reduction is indicated when closed reduction fails in patients with obvious ossification center of capitellum and metaphyseal fragment.Closed reduction & internal fixation may obtain good functional outcomes with satisfactory reduction or cubitus varus with unsatisfactory reduction.Closed reduction yields a high probability of cubitus varus and a poor efficacy. Key words: Fracture; Reset; Fixation