Management of Pediatric Distal Humerus Metaphyseal Diaphyseal Junction Fracture; A Systematic Review and Meta-analysis

Abstract

Abstract Background Fracture at the distal humerus metaphyseal diaphyseal junction (MDJ) in children is less frequently found in literature. Until this moment, there is no gold standard technique regarding its management and most surgeons treat it as a regular supracondylar humerus fracture by conventional pinning. This systematic review explores the relevant literature to assess the efficacy of different techniques. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. We searched online databases including PUBMED/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar. Data from papers that met our general inclusion criteria were extracted and categorized into treatment method groupings. Functional and cosmetic outcomes, demographic characteristics, and complications were the main parameters used to analyze the data. Results Ten (10) retrospective studies met our inclusion criteria with a total of 178 participants of unilateral pediatric distal humerus metaphyseal diaphyseal junction fractures. Most literature chose closed reduction and percutaneous pinning (CRPP) in 7 papers, followed by Elastic Stable Intra-medullary Nails (ESIN) used in 3 papers, then conservative treatment was chosen in 2 papers, while only one paper used lateral miniplate and assisted K-wire and another paper used combined CRPP and Intra- medullary (IM) K-wire. As regards the operation time; ESIN had the lowest time with a mean of 39.7 min (range: 37.5 – 41.9 min), while CRPP had the most prolonged time with a mean of 75.47 min (range: 55.9 – 92.1 min). The lowest healing time was observed in ESIN with a mean of 7.9 weeks (range: 6.8 – 9 weeks) while the most prolonged was in conservative management with a mean of 12 weeks and CRPP lies in between with a mean of 10 weeks. Regarding Flynn’s criteria, all participants received excellent and good except in CRPP; 13 cases were fair and 2 cases were poor. Regarding complications the most commonly observed complication after MDJ fracture was cubitus varus, the highest incidence was in conservative management 33% of cases, followed by CRPP 10.9% of cases, the least incidence was observed in ESIN 3.77% of cases, and none of the cases treated with mini plate developed this complication. Other complications were observed only with CRPP; 8.5% of cases developed fixation loss, 6.2% of cases had significantly reduced range of motion and one case refractured. Conclusion Pediatric distal humerus MDJ fracture should be differentiated from supracondylar fracture regarding management, as conventional pinning techniques are associated with a higher incidence of complications and increased both operative and healing times.