ABSTRACT
PURPOSE: To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view. MATERIALS AND METHODS: A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared. RESULTS: Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II. CONCLUSION: Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.
Subject(s)
Child , Humans , Elbow , Forearm , Humerus , LiftingABSTRACT
Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.
Subject(s)
Child , Humans , Congenital Abnormalities , Elbow Joint , Follow-Up Studies , Humerus , Immobilization , TractionABSTRACT
From January 1988 to December 1991, 39 fractures of the lateral condyle of humerus in children were treated at the Department of Orthopaedic Surgery, Sung-Ac General Hospital. It was possible to follow up from one year to four years and eleven months. The authors have analyzed the method of treatment on the basis of the degree of displacement in the change of Carrying angle and Baumann's angle. The results were as follows; 1. Of the 39 cases, the age incidence was confined to 2 to 12 years of age and the average age of the patients were 5 years. 2. Most fractures were Milch type II (29 cases) in contrast to Milch type I (10 cases). 3. According to the initial displacement of the fracture, 8 cases were Jokob's stage I, 21 cases of stage II & 10 cases of stage III. 4. There were no significant difference in the range of change of Carrying angle and Baumann's angle according to initial displacement of fracture site. However, significant difference in outcome were noticed from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. 5. In all 39 cases, lateral condylar overgrowth (10 cases), cubitus varus (1 cases) and cubitus valgus (3 cases) were noticed as complications but clinical significance was not noted. 6. The above results suggest that internal fixation is recommended for firm fixation although displacement is not severe. In case of Jakob's stage III, anatomical reduction is required in order to reduce additional damage on articular surface and epiphyseal plate caused by excessive manipulation.