Transcondylar fractures of the distal humerus.

We classify transcondylar fractures of the distal humerus into four groups: undisplaced; simple displaced; T-type; and fracture dislocations (Posada's fracture). Our treatment of these fractures is based upon this classification. Undisplaced fractures are treated with immobilization. Displaced fractures are reduced and stabilized with internal fixation. Stabilization of these fractures is difficult because the distal fragments are small and a large portion of their surface is covered with articular cartilage. Transposition of the ulnar nerve allows us to use the cubital tunnel as a point for fixation. We found in our series of 11 patients that undisplaced fractures have the best prognosis. However, all of our patients lost elbow motion, particularly extension. Radiographic signs of post-traumatic arthritis were more pronounced in displaced fractures.

Arthrodesis of digital joints in children.

Many procedures have been described for treatment of unstable, deformed, or painful digital joints; most of these are various types of arthrodeses. These procedures have not been applied to children who have an open epiphysis for fear of damage to the growth plate. This study evaluates an arthrodesis technique that can be used for digital joint instability or deformity in skeletally immature patients. The diagnosis in most of the children in this series was related to non-traumatic congenital or developmental conditions. The joint most often fused was the thumb metacarpophalangeal joint. Results show a high rate of fusion with no interference in digital growth. Complications were minimal.