Intraoperative elbow joint arthrography plus closed reduction and percutaneous pinning in the treatment of distal humeral epiphysis fracture in children

Abstract

Objective To explore the supplemental role of intraoperative elbow joint arthrography in closed reduction and percutaneous pinning in the treatment of distal humeral epiphysis fracture in children. Methods From January 2014 to September 2015, 18 cases underwent closed reduction and percutaneous pinning plus intraoperative elbow joint arthrography. According to the Salter-Harris system, there were typeⅠ(n=6) and type Ⅱ(n=12). There was no case of nervous injury. They were fixed laterally with triple Kirschner wires. Elbow was immobilized by cast or brace in flexion 90 degrees and forearm in pronation. And radiological counterchecks were made after operation. The Kirschner wires were removed after 3-4 weeks and exercises resumed immediately. Results The average follow-up period was 18 (6-24) months. All patients had excellent function of elbow. No elbow of varus deformity occurred. According to the classification scheme of Flynn, the clinical outcomes were excellent (n=14) and good (n=4). Conclusions It is rather difficult to predict the outcomes of closed reduction intraoperatively. Elbow joint arthrography can display distinctly the articular surface of distal humerus. It helps to judge the relationship of fracture site after closed reduction. Percutaneous pinning can maintain good position and prevent postoperative displacements. It helps to decrease the rate of varus deformity postoperatively. Key words: Child; Humeral fractures; Arthography