Comparison of conservative treatment outcomes for proximal humeral epiphyseal fractures in patients of different ages.

BACKGROUND: Several studies have suggested that excellent therapeutic outcomes can be achieved with conservative treatment of proximal humeral epiphyseal fractures in patients younger than 11 years old; however, the outcomes of conservative treatment for children older than 11 years are controversial. To address this problem, this study compared outcomes of conservative treatment for proximal humeral epiphyseal fractures in pediatric patients of different ages. METHODS: The patients were divided into two groups for comparative purposes based on age. Group I consisted of 34 patients who were less than 11 years old (average age: 5 years) and group II included 21 patients who were 11 years of age or older (average age: 14 years). Patients in both groups underwent conservative treatment and follow-up examination, where they first were examined with X­radiography for assessment of deformity, fracture union and loss of reduction. At the final follow-up after 2 years, patients were assessed by an interview and a detailed physical examination including the assessment of shoulder function using the Constant-Murley score. RESULTS: There were no significant differences in the grading scale of varus deformity between the two groups (P > 0.05) after immediate postreduction X­radiography; however, there were significant differences in the grading scale of varus deformity between group I and group II at the 2­year follow-up (P < 0.05). There were no significant differences between the two groups with respect to the Constant-Murley score and arm length discrepancy (P > 0.05) at final follow-up examinations. CONCLUSION: In general, the results suggested that the outcomes, as measured with radiographs, for both older and young children were comparable after immediate postreduction roentgenograms. For long-term follow-up there was a difference between the two groups and the degree of angulation and displacement might be associated with treatment outcomes for older children. Thus, these factors should be considered when treating and evaluating the outcomes for older children.

[Treatment of pediatric distal femur fractures by external fixator combined with limited internal fixation].

OBJECTIVE: To discuss the clinical effects of external fixator combined with limited internal fixation in the treatment of pediatric distal femur fractures. METHODS: From January 2008 to June 2014, 17 children of distal femur fractures were treated by external fixator combined with limited internal fixation. There were 12 males and 5 females, aged from 6 to 13 years old with an average of 10.2 years, ranged in the course of disease from 1 h to 2 d. Preoperative diagnoses were confirmed by X-ray films in all children. There were 11 patients with supracondylar fracture , and 6 patients with intercondylar comminuted fracture. According to AO/ASIF classification, 9 fractures were type A1, 5 cases were type A2,and 3 cases were type C1. The intraoperative and postoperative complications, postoperative radiological examination, lower limbs length and motion of knee joints were observed. Knee joint function was assessed by KSS score. RESULTS: All the patients were followed up from 6 to 38 months with an average of 24.4 months. No nerve or blood vessel injury was found. One case complicated with the external fixation loosening, 2 cases with the infection of pin hole and 3 cases with the leg length discrepancy. Knee joint mobility and length measurement (compared with the contralateral), the average limited inflexion was 10 degrees (0 degrees to 20 degrees), the average limited straight was 4 degrees (0 degrees to 10), the average varus or valgus angle was 3 degrees (0 degrees to 5 degrees). KSS of the injured side was (96.4 +/- 5.0) points at final follow-up, 16 cases got excellent results and 1 good. All fractures obtained healing and no epiphyseal closed early was found. CONCLUSION: External fixator combined with limited internal fixation has advantages of simple operation, reliable fixation, early functional exercise in treating pediatric distal femurs fractures.

[Value of MRI in the diagnosis of radial head fracture with forearm interosseous membrane injury].

OBJECTIVE: To investigate the diagnostic value of MRI in radial head fracture with forearm interosseous membrane injuries. METHODS: From December 2011 to December 2012,26 patients with fractures of capitulum radial in our hospital were collected. There were 15 males and 11 females, ranging in age from 21 to 53 years old,with an average of 37.6 years old. All the patients visited hospital within 72 hours after injuries. X-ray radiography of full ulnar radial length in injured side, CT in injured side (three-dimensional reconstruction if necessary) and MRI (including the elbow and wrist joints) were performed within a week after the injury. The MRI manifestations of the forearm interosseous membrane (with or without damage, the injured location and the injury degree ) and the fractures degree of radial head were observed and compared for the relativity. RESULTS: Radial head fracture from Mason type I to III was associated with the forearm interosseous membrane injury. Radial head fracture degree was positive correlated with forearm interosseous membrane injury degree (P < 0.05). CONCLUSION: Radial head fracture with suspicious forearm interosseous membrane injury is necessary to take MRI for checking for any interosseous membrane injury and injury degree, then choose the right treatment for radial capitulum fracture, only in this way can be helpful for the functional recovery of elbow and forearm.

[Manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humerus fractures in children].

OBJECTIVE: To evaluate the results of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humeru fracturess in children. METHODS: From January 2006 to December 2010, 43 patients with severely displaced proximal humeru fractures were treated with manipulative reduction and percutaneous pin fixation. There were 28 boys and 15 girls,ranging in age from 3 to 17 years,with an average of 11.1 years. Preoperative diagnoses were confirmed by the X-ray films as Neer-Horwitz type III or IV fractures. All the patients were close fractures without nerve or vascular injuries. Under C-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous pinning. Postoperative X-ray confirmed anatomical reduction. Follow-up index were recorded: intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion. Neer score system was used to evaluate shoulder function. RESULTS: All the patients were followed up, and the duration ranged from 3 to 37 months with an average of 20.4 months. The mean Neer score of the injured side was (95.0 +/- 4.3) (ranged, 85 to 100). Thirty-eight patients got an excellent result, 5 good. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities and had a normal range of motion and excellent strength of the shoulder joint. CONCLUSION: The method of manipulative reduction and percutaneous pin fixation is relatively reliable treatment for severely displaced proximal humerus fractures in children.