Extra-articular transphyseal fracture of distal humerus in children aged under three years undergoing closed reduction and percutaneous pinning with an aid of ultrasonic monitoring

Abstract

Objective To explore the feasibility of managing extra-articular transphyseal fractures of distal humerus with closed reduction and percutaneous pinning. Methods From January 2008 to January 2015, the clinical data of 40 children aged under three years with fracture-related separation of distal humeral epiphysis undergoing closed reduction and percutaneous pinning with an aid of ultrasonic monitoring were retrospectively analyzed. There were 24 boys and 16 girls with an average age of (22.37±6.01)(11-34) months. According to the Salter-Harris classification scheme, the fractures were classified into types Ⅰ (n=12) and Ⅱ (n=28). Their union time of bone, radiographic data, complications, hospitalization length and discharge data were comprehensively analyzed. The Flynn’s criteria were utilized for functional and cosmetic outcomes during the last follow-up. The final outcomes were classified as excellent, good, fair or poor. And the complications of nonunion, delayed union and infection, etc were recorded. Results The average follow-up period was 23.4(19-30) months, the post-injury time to surgery (2.40±0.98) days. Hospitalization length was (3.35±0.80) days and the average bone union time (3.65±0.53) weeks. The age of injury, post-injury time to surgery and type of epiphyseal injury were not related with a loss of carrying angle (P>0.05). There was also no clinically evident sign of cubitus valgus, hyper-extension, loss of motion, pin site infection or iatrogenic nerve palsies. And no additional surgery was required. According to the Flynn’s criteria, the outcomes were excellent (n=12) and good (n=28). Conclusions Obtaining a clear image is vital for diagnosing and treating distal humeral epiphyseal fracture in children. And ultrasound may monitor distal humeral epiphyseal fracture in real-time during closed reduction and guide an accurate fixation of Kirschner’s wire. Key words: Humerus; Epiphyses; Fractures, bone; Closed reduction; Ultrasonography