Using the Medial and Lateral Humeral Lines as an Adjunct to Intraoperative Elbow Arthrography to Guide Intraoperative Reduction and Fixation of Distal Humerus Physeal Separations Reduces the Incidence of Postoperative Cubitus Varus

Comparative Outcomes of Treatment Strategies for Traumatic Distal Humerus Physeal Separation in Children: A Systematic Review

Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1-46 months) with a mean follow-up of 37 months (range: 0.5-516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension-flexion arc was 2.1° to 127.8° (range: -10-140°). The mean Bauman's angle was 72.4° (range: 66-79°), the mean shaft-condylar angle was 43.8° (range: 25-59°), the mean humeral length was 21.9 cm (range: 15.5-25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus-19° valgus). According to Flynn's criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate.

Epiphyseal displacement of the distal humerus in a neonate: a case report

Epiphyseal displacement of the distal humerus is rare and difficult to diagnose. In addition, the literature on the prognosis and treatment is limited. Here, we present a case of distal humeral physeal separation with significant displacement in a neonate. A favorable outcome was obtained following closed reduction and percutaneous fixation with Kirschner wires assisted by arthrography. This report adds valuable information on this subject to the existing literature.

Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND

Neonatal distal humeral physeal fractures are rare and difficult to diagnose. Thus, missed diagnoses and delayed healing are possible. Few studies have reported surgical treatment, because a callus may develop at the fracture site 5 d after the fracture, resulting in difficult reduction, and reduction of the limb may cause further physeal injury. Other surgical challenges include the provision of adequate anesthesia and complexity of the operation. However, without appropriate reduction and fixation, a varus elbow deformity may develop. Manual reduction and percutaneous pin fixation are ideal treatment options.

CASE SUMMARY

A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted, and diagnosed with delayed physeal fracture of the distal humerus based on physical examination, ultrasonography, and magnetic resonance imaging. The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography. Postoperatively, the reduction was successful. The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.

CONCLUSION

The techniques of manual reduction and percutaneous pin fixation, to treat neonatal distal humeral physeal fractures, are safe and reliable.