INTRODUCTION: The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion. METHODS: The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed. RESULTS: A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection. CONCLUSION This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.
Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fluoroscopy ; Fracture Fixation, Intramedullary ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; Iatrogenic Disease ; Male ; Pediatrics ; Radiography ; Retrospective Studies ; Ulnar Nerve

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.
Accidental Falls ; *Bone Wires ; Child ; Fracture Fixation ; Humans ; *Humeral Fractures ; Male ; Multiple Trauma ; Radiography ; *Radius Fractures ; *Upper Extremity/diagnostic imaging/injuries/surgery

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochlea-coronoid articulation and hence to maintain the intrinsic stability of the elbow.
Accidents, Traffic ; Adolescent ; Clavicle ; diagnostic imaging ; injuries ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Radius Fractures ; diagnostic imaging ; surgery

T-condylar fracture is rare in paediatric age group, especially in skeletally immature children less than 9 years old, with very few cases reported in available literature. We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us, 10 days after the injury. The child was diagnosed as having a displaced T-condylar fracture on plain radiograph. Open reduction and internal fixation with K-wires was performed. At 2 years follow-up, the child had good range of motion at elbow with 5°of cubitus varus. With this background we discuss the pertinent principles of management of T-condylar fractures in skele-tally immature children.
Child, Preschool ; Elbow Joint ; injuries ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Time Factors

BACKGROUND: Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally. METHODS: Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications. RESULTS: Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3degrees (range, 0degrees to 10degrees) of extension and 135.9degrees (range, 125degrees to 145degrees) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection. CONCLUSIONS: Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Humeral Fractures/radiography/*surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Orthopedic Procedures/adverse effects/instrumentation/*methods ; Pain, Postoperative ; Prospective Studies ; Range of Motion, Articular ; Return to Work ; Treatment Outcome

OBJECTIVETo explore therapeutic effects of Modified pinning combined with external tension band for the treatment of Gartland type III humeral supracondylar fractures in children.

METHODSFrom February 2009 to November 2010, 79 children with Gartland type III humeral supracondylar fractures were treated by modified pinning (pinning cross internal and external condyle assisted with lateral condyle) combined with external tension band (crossing needle end and hooking around) through lateral approach of elbow. There were 47 males and 32 females, with an average age of 8.7 years (ranging from 2.5 to 14 years). The time from injury to operation was 2 h to 8 d. The elbow joint function and Carrying angle were observed before and after treatment. The Flynn criteria were used to evaluate therapeutic effects.

RESULTSSixty-one patients were followed up (18 patients' data were lost) for 6-30 months (mean 13.5 months). According to Flynn criteria, 53 patients got excellent result, 7 good and 1 fair.

CONCLUSIONTreatment of child Gartland type III humeral supracondylar fractures with modified pinning combined with external tension band through lateral approach of elbow is believed to be an ideal method, which has advantages of reliable fixation, rapid recovery and less complications.

Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fracture Fixation ; instrumentation ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Mechanical Phenomena ; Radiography ; Treatment Outcome

OBJECTIVETo study clinical effects of plaster combined with splint for the treatment of Gartland type 1I humeral fractures.

METHODSFrom March 2002 to May 2006, 24 children with humeral supracondylar fractures of Gartland type ill were reviewed. Among the patients, 14 patients were male and 10 patients were female, ranging in age from 4 to 12 years, averaged 6.6 years. Ten patients had injuries in the left and other 14 patients had injuries in the right limb. Firstly, the patients were treated with manipulative reduction to maintain the length of humerus without emphasis on anatomic reduction. Then, the patients were treated with external fixation using plaster for 5 to 7 days, and secondary manipulative reduction after swelling disappeared. Lastly, the patients were treated with external fixation using splint for 4 to 5 weeks until fracture union.

RESULTSAll the patients were followed up, and the duration ranged from 5 months to 2 years, with an average of 1.2 years. All the patients had no complications such as neurovascular injury, myositis ossificans, forearm compartment syndrome and Volkmann contracture. According to ZHU Xiao-ting evaluation criteria for humeral supracondylar fractures in children, 12 patients got an excellent result, 8 good, 3 poor and 1 bad.

CONCLUSIONTreatment of child humeral supracondylar fractures with plaster and splint has several advantages such as avoiding serious soft tissue injuries around fractures due to many times reduction, fracture dynamic correction to obtain satisfactory reduction, reducing complications, obtaining good reduction, and restoring elbow function in a relatively short period of time.

Casts, Surgical ; Child ; Child, Preschool ; Female ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Splints

A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation, combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.
Adolescent ; Elbow Joint ; diagnostic imaging ; injuries ; Female ; Fracture Fixation, Internal ; Fracture Healing ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Radiography

Adolescent ; Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography

OBJECTIVETo discuss the method and effects of treatment of minimally invasive percutaneous plate osteosynthesis (MIPO) through anterior approach for the treatment of humerus shaft fractures.

METHODS2006.1 to 2007.10,15 patients with humerus shaft fractures were treated with MIPO through anterior approach. There were 11 males and 4 females, ranging in age from 16 to 59 years, with an average of 35 years old. The duration of the disease was 7.5 days on average (5 to 10 days). Six patients had Type A fractures, 8 Type B, and 1 Type C according to AO classification. The AO LC-DCP with diameter of 4.5 mm was chosen in the operation. The patients were physically examined preoperatively and postoperatively, the range of motion of shoulder and elbow joint was observed, and the joint function was included.

RESULTSAll the patients were followed up for a period ranging from 5 to 18 months,averaged 10 months. In terms of Gill ipsilateral total shoulder and elbow arthroplasties, 12 patients got an excellent result (> or = 80 scores), 3 good (between the scores of 66 and 79). The Gill score increased from preoperative (59.33 +/- 8.21) to postoperative (84.67 +/- 5.81). Fractures were healed after 2 to 3 months after operation, and patients resumed daily life without the complications of nervous lesion, incision infection, internal fixation failure and nonunion of fracture etc.

CONCLUSIONIt is feasible for the treatment of humerus shaft fracture using MIPO through anterior approach,to avoid radial nerve injury and to prompt fracture union.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Radiography ; Treatment Outcome ; Young Adult