Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods / Avaliação das fraturas diafisárias do úmero tratadas cirurgicamente e comparação entre os métodos de fixação cirúrgica

ABSTRACT Objective: The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and describe its epidemiology. Methods: Retrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between December of 2014 and June of 2016 in a trauma reference center. All medical records were reviewed in search of epidemiological data referent to the trauma and post-operative results, including radiographic healing of the fracture and related complications. Results: Fifty-one patients were included, mostly male (78.4%), with an average age of 35.02 years. The most common trauma mechanism was a traffic accident (56.9%) followed by same-level falls (17.6%). No statistically significant difference was found between healing time comparing surgical fixation techniques, including open reduction and internal fixation, minimally invasive technique, intramedullary nailing, and external fixation. Conclusion: Although each technique has inherent advantages and disadvantages, all fixation methods proved to be adequate options for the surgical treatment of humeral shaft fractures with high rates of healing and low rates of post-operative complications.

RESUMO Objetivo: Descrever o perfil dos pacientes com fraturas diafisárias do úmero, bem como analisar os resultados das diferentes modalidades cirúrgicas. Método: Estudo retrospectivo baseado na identificação de todos os casos de fraturas diafisárias de úmero submetidas a tratamento cirúrgico entre dezembro de 2014 e junho de 2016 em um serviço de referência em trauma, bem como na análise dos respectivos prontuários, e que buscou dados epidemiológicos referentes ao trauma e resultados pós-operatórios, inclusive tempo de consolidação e complicações relacionadas. Resultados: Foram incluídos 51 pacientes, dos quais a maioria do sexo masculino (78,4%), com média de 35,02 anos. O mecanismo de trauma mais prevalente foram acidentes de trânsito (56,9%), seguidos de quedas de mesmo nível (17,6%). Não foi encontrada diferença significante entre o tempo de consolidação dos diferentes métodos, inclusive redução aberta e fixação interna com placa e parafusos, técnica minimamente invasiva com placa em ponte, haste intramedular e fixação externa. Conclusões: Todos os métodos cirúrgicos avaliados mostraram-se adequadas opções para o tratamento cirúrgico das fraturas da diáfise do úmero, ainda que tenham vantagens e desvantagens inerentes a cada técnica, com altas taxas de consolidação e poucas complicações relatadas.

Fracturas de tratamiento quirúrgico alrededor del codo en niños: descripción epidemiológica en Hospital Clínico San Borja Arriarán / Surgical treatment fractures around the elbow in children: epidemiological description in Clinical Hospital San Borja Arriaran

Introducción: los traumatismos de codo tienen una alta incidencia en la población infantil, la fractura de esta zona corresponde al 5 a 10 por ciento del total de fracturas en niños. El objetivo de nuestro trabajo es hacer una descripción epidemiológica de las fracturas de codo en niños operadas en el Hospital Clínico San Borja Arriaran. Materiales y métodos: Estudio retrospectivo, descriptivo. Se realizó revisión de fichas electrónicas de pacientes de edad pediátrica operados de fracturas alrededor del codo en el HCSBA desde el 1 de junio al 31 de 2014. Resultados: Se estudiaron 25 pacientes, 64 por ciento de sexo masculino y 36 por ciento de sexo femenino. La edad promedio fue de 5,5 años. Fracturas supracondilea de humero correspondieron a 64 por ciento, epicondilo de humero 24 por ciento, epitróclea de humero 8 por ciento y olecranon y cúpula radial 4 por ciento. Discusión: Las fracturas supracondileas de humero son la lesión más frecuente de codo en los niños. Las fracturas de epicondilo son la segunda en frecuencia. Las fracturas de epictroclea representan aproximadamente 10 por ciento, mientras que las fracturas del olécranon son relativamente poco comunes en los niños. Conclusiones: nuestro centro tiene una epidemiologia similar a la descrita por la literatura internacional en cuanto a frecuencia, complicaciones asociadas y presentación clínica.

Introduction: elbow injuries have a high incidence among children, breaking this area corresponds to 5-10 percent of all fractures in children. The aim of our work is to make an epidemiological description of the elbow fractures in children operated in the Hospital Clinico San Borja Arriaran. Materials and methods: Retrospective, descriptive study. Review of electronic records of pediatric patients operated on fractures around the elbow in the HCSBA from 1 June 31, 2014 was performed. Results: 25 patients, 64 percent male and 36 percent female, were studied. The average age was 5.5 years. Supracondylar humerus fractures accounted for 64 percent, 24 percent epicondyle of the humerus, 8 percent medial epicondyle of the humerus, olecranon and radial head 4 percent. Discussion: Supracondylar humerus fractures are the most common elbow injury in children. Epicondyle fractures are the second in frequency. Epictroclea fractures represent approximately 10 percent, while the olecranon fractures are relatively uncommon in children. Conclusions: our center is similar to that described by the international literature in frequency, associated complications epidemiology and clinical presentation.

Pattern of Fractures in Non-Accidental Injuries in the Pediatric Population in Singapore

BACKGROUND: Fractures as a result of non-accidental injuries (NAI) are not uncommon among children. The purpose of our study was to describe the incidence, demographic characteristics, and associated risk factors in patients with NAI in a multiethnic Asian cohort. METHODS: A retrospective record review of patients admitted to our hospital between September 2007 and 2009 with the diagnosis of NAI was conducted. RESULTS: A total of 978 children were reported with suspicion of NAI. Among them, 570 patients (58.28%) were diagnosed with NAI. Fractures were observed in 35 children (6.14%). NAI fractures were highest among female infants (73.3%). The biological father was the most common known perpetrator of NAI (n = 155, 29.0%). The most common perpetrator sadly remained unknown (n = 14, 40%). All NAI fractures were closed (n = 35, 6.14%), and the most commonly affected bone was the humeral shaft (n = 10, 28.57%) with an oblique configuration. Age < 1 year and parental divorce were significant risk factors associated with these fractures. CONCLUSIONS: The skeletal injury pattern and risk factors highlighted in our study will help treating physicians identify patients susceptible to NAI, as many of these patients are young and vulnerable. Protective measures can be initiated early by recognizing these injuries and preventing further physical and psychological harm to the child.

Closed reduction and percutaneous pinning of displaced supracondylar humeral fractures in children

Supracondylar fracture of the distal humerus is the most common elbow fracture in children [60% of elbow fractures]. The peak age for Supracondylar fractures is between 6 and 7 years. This fracture is classified into extension or flexion injuries based on radiologic appearance. Between November 2002 and August 2005 120 child in the age group between 4 years and 13 [with mean age 7.1 years] including 80 boys [67.7%] and 40 girls [33.3%] with left elbow involvement in 71 patients and right elbow in 49 patients with displaced Supracondylar humeral fracture were treated by closed reduction and percutaneous pinning under image intensifler control using crossed pins for fixation [1.6 or 1.8 K-wires].The follow up ranged between 9 and 12 months. The patients are assessed according to both functional [Range of Motion] and Cosmetic factors [Carrying angle] and the overall results were excellent in 89 cases [74.1%], good in 21 cases [17.5%],fair in 2 cases [1.7%] and poor in 8 cases [6.7%] losed Reduction and percutaneous pinning is safe, cost effective and allows direct assessment of the carrying angle of the extended elbow after fracture stabilization

Refractures of the Upper Extremity in Children

Purpose: To investigate the etiologic factors related to refractures of the upper extremity in children. Patients and Methods: Eighteen refractures were divided into three groups according to the location of the initial fractures. They were analyzed in terms of the type of refractures, fracture patterns, and the existence of an underlying deformity. Results: Of nine supracondylar fractures of the humerus, two involved refractures at the supracondylar region, and the other seven involved the lateral condyle. Underlying cubitus varus was present in six cases. Of three lateral condylar fractures of the humerus, one had a refracture at the supracondylar region, and two cases involved the lateral condyle. One had an underlying cubitus varus. All but one case in the humeral fractures group were late refractures, and were treated with surgery. Of six repeat forearm fractures, five were early type and occurred at the original site within nine weeks, four at the diaphysis of both bones of the forearm, and one at the diaphysis of the ulna. All cases in the forearm fractures group, save one, had volar angulation before the refracture, and were treated conservatively. Conclusion: In the humerus, the underlying cubitus varus was the most important predisposing factor for refractures and lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis was related to refractures, and complete and circular consolidation of the primary fracture of the forearm was thought to be important in prevention.

Birth-related fractures of long bones.

OBJECTIVE: Birth-related fractures of the long bones are not rare. METHODS: This study presents a retrospective analysis of birth-related fractures of long bones seen at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. RESULTS: There were 21 fractures (clavicle 11, femur 6, humerus 3 and radius 1) during the 10-year period, with an overall incidence of 0.67 per 1000 live births. Neonates with fractures had higher birth-weight (p<0.001) as compared to the control group and other parameters like gestational age and mode of delivery were not significant. CONCLUSION: It is recommended that neonates with fractures must have quicker appointments in the outpatient clinics to prevent deformities and secondly those with fracture clavicles should be thoroughly evaluated to rule out damage to brachial plexas as well.

Fracturas supracondíleas de húmero en niños (1975-2001) / Humeral supracondylar fractures in children (1975-2001)

Estudio retrospectivo con objeto de establecer las características epidemiológicas de los 110 pacientes pediátricos quienes acudieron a la emergencia del Hospital José María Benítez, Edo. Aragua, con diagnóstico de fractura supracondílea del húmero, desde 1975 hasta 2001. La mayor incidencia se presentó en niños varones, con edad media de 6,33 años, 38,18 por ciento recibieron tratamiento con reducción cerrada y fijación percutánea, evolucionando satisfactoriamente sin ningún tipo de complicación

Bone injuries during delivery.

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.

Fracturas supracondileas de codo en ninos / Supracondyleal elbow fractures in children

Se estudiaron los diferentes metodos empleados para tratamiento de las fracturas supracondileas para determinar con cual de ellos se obtenian mejores resultados. Se revisaron 750 casos de fracturas tratadas en el Hospital Infantil y en la Clinica San Rafael desde 1970 hasta 1983. Se incluyeron en el estudio 169 pacientes con un seguimiento que permitia obtener datos clinicos y radiologicos para hacer una evaluacion adecuada. 116 eran hombres (68.6%) y 53 mujeres (31.4%), el codo izquierdo se vio afectado mas que el derecho. La edad promedio fue de 6 anos con rango de 7 meses -14.6 anos. Hubo 7 fracturas abiertas (42.2%), 12 grado I(7.1%), 14 grado II (8.2%), 29 grado III (17.1%), 114 grado IV (67.4%). El 82%consulto durante las primeras 24 hs despues del trauma con un promedio de 4.8 hs y un rango de 9-40 dias. El edema y la deformidad fueron evidentes en el 70%de los casos. El 70%de las fracturas se redujeron en las primeras 6 hs y se realizaron los siguientes procedimientos: inmovilizacion en yeso BMC inmediata en 12 casos (7.1%) todos grado I. Traccion esqueletica tipo Lymann-Smith o Dunlop en 42 casos (24.8%) estando entraccion en promedio 9 dias y posteriormente un yeso BMC. Reduccion cerrada mas fijacion percutanea en 82 casos (48.5%); reduccion cerrada mas inmovilizacion en flexion maxima en 33 casos (19.5%), el tiempo promedio de hospitalizacion fue de 5.3 dias. El yeso o los clavos se retiraron en promedio a las 3 semanas. Como complicaciones se presentaron infeccion superficial (3), migracion de los clavos (2), neuropraxia pasajera (13), cubito varo (20), cubito valgo (4), lesion nerviosa definitiva (2) ...