ABSTRACT
BACKGROUND: Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries. METHODS: One hundred and thirty-nine displaced medial epicondyle fractures were surgically treated and reviewed. A valgus stress test was performed on each child under general anesthesia or sedation. Functional outcome was assessed using a scoring system based on a series of clinical and radiographic criteria. The mean age of patients at the time of accident was 11.9 years. Mean follow-up was 3.9 years. All fractures had associated with instability of the elbow. A posterolateral elbow dislocation was associated in 80 fractures. The medial epicondylar fragment was anatomically reduced and fixed in all cases. RESULTS: The final result was excellent in 130 cases and good in 9 cases. Elbow were stable and pain free in all patients. Normal elbow range of motion was reported in 133 cases. Union was achieved in all cases. Among these cases, nine had presented a <
Subject(s)
Elbow Injuries , Humeral Fractures/surgery , Adolescent , Child , Female , Follow-Up Studies , Humans , Humeral Fractures/complications , Humeral Fractures/diagnostic imaging , Joint Instability/etiology , Joint Instability/surgery , Male , Radiography , Retrospective StudiesABSTRACT
Out of 210 children suffering from severely displaced supracondylar fractures, 76 (36%) presented with immediate neurovascular complications: 47 (22%) were neurological, 16 (8%) vascular and 13 (6%) both. Injury to two nerves simultaneously was observed in six patients. The median nerve was affected in 28 cases, the ulnar nerve in 25 and the radial nerve in 13. Posterolateral displacement was associated with 86% of damage to the median nerve and 56% of damage to the ulnar nerve. Posteromedial displacement was associated with all incidents of injury to the radial nerve with one exception. Each patient made full neurological recovery, spontaneously and following primary or secondary neurolysis performed on nerve injuries in continuity. Two situations of primary abolition of the radial pulse were encountered, one involving a pink hand in 12.5% of cases and the other involving a white hand in 1.5% of cases. There was posterolateral displacement in three out of four patients. Postoperative vascularization was revealed by immediate return of the radial pulse in 26 patients and delayed return in three others. Urgent anatomical reduction of the fracture and its early fixation are crucial. A conservative therapeutic approach is customary in the majority of neurovascular complications. Prognosis is generally excellent. Ischaemia of the limb and total ruptures of the nerve are very rare.