Functional outcome of the elbow in toddlers with transphyseal fracture of the distal humerus treated surgically

Abstract

Purpose To quantitatively evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) in children with transphyseal fracture of the distal humerus (TFDH) treated surgically. Methods During the period between 2005 and 2015, a total of 16 patients (ten male, six female) met the inclusion criteria. Mean age at the time of injury was 18 months (11 to 37) and mean follow-up was 42.3 months (6 to 98). Based on a modified version of Delee’s classification (Group A to C), the clinical and radiographic outcome of TFDH in toddlers treated surgically were retrospectively evaluated. Results Mean humeral-ulnar (HU) angle of the injured and non-injured side was 1.2° (-18° to 14°) and 8.8° (2° to 19°), respectively (p = 0.001). Closed and open reduction showed similar HU angle values (p = 0.682). Mean MEPS score of the injured and non-injured side was 85.5 points (70 to 95) and 95 points (90 to 100), respectively (p = 0.002). No significant association was identified between MEPS score and gender, side, age at trauma, direction of displacement, time from trauma to surgery, presence of ossified capitellum, type of surgery and type of fracture. Conclusion Functional outcome was generally good regardless of surgical procedure performed, closed or open and type of fracture according to modified Delee’s classification. However, a residual cubitus varus was commonly observed among toddlers with transphyseal fractures of the distal humerus. Level of evidence: Level IV – Therapeutic study

Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

“…In addition to the varus on the coronal plane, the cubitus varus can also include the three-plane deformities of the overextension on the sagittal plane and the internal rotation on the horizontal plane [4]. Besides, due to the poor ability of distal humeral epiphysis to correct the existed varus deformity, the cubitus varus deformity will persist into adulthood without any improvement [5, 6]. Thus, the cubitus varus deformity will not only affect the esthetic appearance and restrict the elbow motion, but also delay the daily life and learning of adolescents to a certain extent [7].…”

Ulrasonography guided Closed Reduction in the Treatment of Displaced Transphyseal Fracture of the Distal Humerus

“…Secondly, owing to the less remodeling potential of the distal humerus, the cubitus varus seem to be not progressive [27] . an the inadequate reduction could be the main cause of cubitus varus in toddlers with TFDH 6 . In present study, all the reduction was guided by the US, and nearly anatomy reduction could be guaranteed in most cases which thus avoiding the cubitus varus effectively.…”

“…Owing to the low incidence of TFDH, many previous studies just reported case reports on this injury with limited impacts on the treatment of TFDH. Recently, some studies reported retrospective studies with small number of consecutive cases [5,6] . However, the consensus on the normalized treatment has not been reached, and it is still a need of further seeking on the most appropriate treatment strategy for the TFDH.…”

Transepiphyseal separation of distal humerus: A case report and review of literature

“…Many authors recommend avoiding late manipulation after 4-7 days) owing to concerns about avascular necrosis, trauma to the growth plate, and disturbance of growth [11]. Some authors prefer intraoperative arthrography for these patients because of the diffi culty in visualizing the distal humeral anatomy in very young children [1,4], for obtaining good alignment of fracture and stability in such cases [12].…”

“…Transepiphyseal Fracture of Distal Humerus ( TFDH ) or epiphysiolysis of distal humerus is a rare injury seen in children younger than three years of age [1]. It is the least commonest of all physeal injuries representing 3.9% of them in this age group [2].…”