A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures.

BACKGROUND: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. MATERIALS AND METHODS: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant-Murley score) between the two groups of patients. RESULTS: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). CONCLUSION: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Our experience with a modified prying-up technique for closed reduction of irreducible supracondylar humeral fractures.

Satisfactory reduction of some displaced pediatric supracondylar humerus fractures is not achievable via closed reduction, thus necessitating open procedure, which increases the incidence of complications. Using percutaneous prying-up technique to assist closed reduction may reduce the requirement for transform to an open operation. We retrospectively reviewed displaced pediatric supracondylar humerus fractures treated by the same surgeon from September 2021 to January 2024,with 134 subjects meeting criteria for inclusion. These children were divided into two groups. In Group A(n = 61),the prying-up technique was used to assist with closed reduction of fractures. Group B(n = 73) included fractures treated with conventional manual traction. To balance group size,12 fractures from group A were randomly removed, leaving a final 61 patients in each group. Demographics, operative time, the rate of failed closed reduction, complications and radiographic results were analyzed. The operative time was significantly less in Group A as compared with Group B(mean difference, - 7.22; [95% confidence interval (CI), - 8.49 to - 5.94]; p < 0.001). The rate of failed closed reduction were significantly lower in Group A as compared to Group B(2 of 61 vs. 10 of 61, p = 0.015).However, we found no difference in terms of the radiographic results and complications between the two groups(p > 0.05). percutaneous prying-up technique significantly improves the efficiency of surgery and reduces rate of failed closed reduction of supracondylar humeral fractures in pediatric patients. Level III, retrospective comparative study.See Guidelines for Authors for a complete description of levels of evidence.

Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation.

BACKGROUND: Humeral shaft fractures account for up to 3% of all fractures, but complex forms of those fractures (type AO/OTA B or higher) are rare. Plate and screw fixation of the fracture are rated as consolidated from 80 to 97%. Reported complications include non-union, secondary radial nerve palsy and infection. Minimally invasive plate osteosynthesis (MIPO) should provide the same union rate as open reduction and internal fixation (ORIF) but potentially with fewer complications. The aim of our study was to review patients treated for complex humeral fractures with ORIF through an extended delto-pectoral approach using a long pre-contoured locking plate. The morbidity of the open approach, complication rates, union rate and clinical outcomes were assessed. METHODS: We performed a retrospective analysis of 26 consecutive complex humeral shaft fractures (7 males, mean age 59 years; 19 females, mean age 67 years) treated in our institution with a long pre-contoured locking plate between June/2011 and December/2017. Fracture healing was evaluated with standard radiographs. Eventual complications and the morbidity of the approach were assessed through chart review. The final clinical outcome and quality of life were assessed via telephone interview with DASH score and EQ-5D-3 L in 25 of the 26 patients included. RESULTS: There were no complications related to the open approach with uneventful wound healing in all cases without any infections. Mechanical complications occurred in 3 cases (11%): one tuberosity dislocation (revised) and two plate failures (one revised). Postoperative radial nerve palsy was observed in two patients (7%), of which one was transient, the other was persistent. The plate was removed in 4 cases (15%). The average radiological and clinical follow-up was 21 months (range: 12-56). At 12 months follow-up complete fracture healing was confirmed in 22 out of 26 cases and in three more patients after 18 months. After an average of 44 months, the mean DASH score was 35 (SD ± 15.83) points; the EQ-5D-3 L score 0.7 (SD ± 0.31). CONCLUSION: ORIF with a long locking plate though an extended delto-pectoral approach is certainly still a viable option to treat complex humeral shaft fractures with good soft tissue and bone healing as well as good functional recovery. No increased morbidity was attributed to the open surgical approach. In our series, radial nerve palsy could not be completely avoided, accentuating the potential risk of this specific fracture in close proximity to the radial nerve. TRIAL REGISTRATION: Ethics Committee: Ethikkommission Ostschweiz (EKOS), Project ID: 2019-00323.

Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow.

INTRODUCTION: In our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. MATERIALS AND METHODS: We reviewed the data of children operated on for lateral condyle fractures between 2010 and 2020. Patients were classified as follows: 1. fractures treated with metallic (KW group), 2. fractures treated with resorbable implants (BR group). We compared the distribution of age, sex and fracture type in each group. Operative times of the two techniques were also recorded and compared. We analysed the X-rays taken one year after the injury and measured the following parameters: presence of possible non-union, varus or valgus deviation, lateral spur formation. Patients whose follow-up period was less than one year were excluded. For categorical data, group comparisons were performed with Chi-square test or Fisher's exact test, depending on the sample size. The evaluation of discrete variables was performed with Mann-Whitney U test. RESULTS: 42 patients met the above criteria. We found 19 children in the Kirschner -wire + tansion band wire (KW) group and 23 in the Bioresorbable pin + tension band suture (BR) group. There were no significant differences between the study groups in terms of age, sex, left-right ratio, number of complications, operation time, number of Jacobs II and III cases or follow-up time. The operation time was on average 5 min longer in the bioresorbable group (K-wire mean = 62.1 min, Bioresorbable mean = 67 min), this difference, however, is not statistically significant (P = 0.177). In terms of minor and major complications, there was no statistically significant difference between the two groups. (P = 0.729). CONCLUSIONS: We did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary. The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.

Development of the humeral head offset index for control of humeral torsion.

BACKGROUND: Control of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus. METHODS: The Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman's rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC). RESULTS: Both in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI. CONCLUSIONS: The HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side.

Medium-term clinical results in the treatment of supracondylar humeral fractures in children: does the surgical approach impact outcomes?

BACKGROUND: Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. MATERIALS AND METHODS: Thirty-one pediatric patients treated for SCHF-19 classified as Gartland II and 12 as Gartland III-were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). CONCLUSIONS: Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. TRIAL REGISTRATION: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). LEVEL OF EVIDENCE: Therapeutic level III.

Total elbow arthroplasty and hemiarthroplasty in the treatment of distal humerus fractures in the elderly: Experience from a tertiary referral centre.

BACKGROUND: There is no clear consensus on whether total elbow arthroplasty (TEA) or hemiarthroplasty (HA) is superior for treating distal humerus fractures in the elderly. This study analysed the functional outcomes and re-operation rates following TEA and HA for intra-articular distal humerus fractures in patients aged ≥65 years. METHODS: 19 patients (TEA = 12, HA = 7) treated between 2016 and 2022 were retrospectively reviewed. Mean age was 73 years and mean follow-up was 46 months. Functional outcomes and quality of life were assessed using the Mayo Elbow Performance Score (MEPS), Quick-DASH (Q-DASH), Oxford Elbow Score (OES), SF-12 Physical Component Score (PCS) and Mental Component Score (MCS), and EQ-5D. Complications requiring re-operation were recorded. RESULTS: HA showed superior outcomes in MEPS (93.6 vs 75.0, p = 0.0339), Q-DASH (13.3 vs 31.3, p = 0.0182), OES (41.7 vs 33.2, p = 0.0346), SF-12 PCS (55.5 vs 36.9, p = 0.0008) and EQ-5D (83 vs 67, p = 0.0023). One HA patient required revision to TEA for prosthetic joint infection. One TEA patient required revision for a periprosthetic ulna fracture. CONCLUSION: HA provides better functional outcomes compared to TEA in the treatment of distal humerus fractures in the elderly. Data is limited by selection bias and low patient numbers with a multicentre randomised controlled trial warranted.

Ultrasound evaluation of radial nerve injuries by cortex overlapping screw tips after internal fixation of humeral fractures: a cadaveric study.

PURPOSE: The radial nerve may be painfully irritated or damaged by open reduction and internal fixation (ORIF) of humeral fractures. Secondary radial nerve lesions after ORIF of humeral shaft fractures are described in up to 16%. Not only peripheral nerves but also orthopaedic instruments and osteosynthesis material are well visible by ultrasound. The aim of this study was to evaluate the accuracy of ultrasound in assessing the relation between the bone overlapping screw tips and the radial nerve close to the humeral bone. METHODS: Ultrasound-guided drilling was used to place screws as close as possible to the radial nerve in 8 humeral bones of four cadavers. The relation between the radial nerve and the screw tips was assessed by high-resolution ultrasound, and the overlap of all screw tips over the bone was measured by ultrasound and fluoroscopy. Thereafter, the findings were validated by anatomical dissection. RESULTS: We could correctly identify all screw tips and their relation to the radial nerve by ultrasound. In 7 of 8 cases, the screw tip had direct contact with the radial nerve. The overlaying length of the screw tip was accurately measured by using ultrasound in all cases. In contrast fluoroscopy underestimated this length in 50% of cases. CONCLUSION: With this study, we show that ultrasound can reliable visualize the screw tips and its relation to the radial nerve. Ultrasound is a promising diagnostic tool to evaluate patients with radial nerve irritations or lesions after ORIF of humeral fractures. Furthermore, ultrasound could be an adequate tool to guide drilling.

Step-cut osteotomy for cubitus varus deformity with application of patient-specific instrument in children: a preliminary report.

PURPOSE: The step-cut osteotomy has been recognized as a valuable approach for addressing cubitus varus deformity, albeit one that necessitates technical proficiency. This study aims to evaluate the efficacy of the modified step-cut osteotomy technique in conjunction with patient-specific instruments by clinical and radiological assessment. METHODS: We conducted a retrospective review of patients who underwent modified step-cut osteotomy with the use of patient-specific instruments in conjunction with Kirschner wires fixation for the correction of cubitus varus deformity between April 2016 and April 2022. Follow-up was performed for a minimum of two years, during which pre-operative and post-operative clinical and radiological parameters were compared. RESULTS: Fifteen patients were enrolled in this study. The mean pre-operative humeral-elbow-wrist (HEW) of the affected side was -21.7° (ranging from -14° to -34°), while the normal side was 9.4° (ranging from 5° to 15°). The post-operation HEW of affected side was 9° (ranging from 4° to 16°). There was no significant difference between the normal side and affected side after operation (p = 0.74). Pre-operative range of motion in the affected side was 130°, while the post-operative range of motion was 132°. Fourteen patients (93.3%) were pleased with the overall appearance of their elbow. None lazy-S deformity was observed in these cases. There were no major complications. CONCLUSION: The modified step-cut osteotomy technique, utilizing patient-specific instrument in conjunction with Kirschner wires fixation was found to be a safe, reliable, and technically easy procedure for correcting cubitus varus deformity.

Short-term complication rates of open reduction and plate fixation and intramedullary nailing in the treatment of humeral shaft fractures: a propensity score matched analysis.

INTRODUCTION: This is a retrospective cohort study designed to compare short-term postoperative complication rates between closed humeral shaft fractures treated by open reduction and internal fixation (ORIF) versus intramedullary nailing (IMN), as well as secondary independent risk factors for adverse outcomes. MATERIALS AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using CPT codes to identify patients that underwent an open reduction and plate fixation or intramedullary nailing procedure for a closed humeral shaft fracture from 2010 to 2021. Cohorts were matched using propensity scores to account for demographic differences and rates of complications were compared between the two groups. RESULTS: From the database, a total of 4,222 patients were identified who met inclusion criteria, with 3,326 and 896 undergoing ORIF and IMN respectively. After propensity score matching, 866 of the nearest-neighbor matches were included in each cohort for a total of 1,732 patients in the final analysis. The rate of any adverse event (AAE) was significantly higher in the ORIF cohort (16.3%) than the IMN cohort (12.1%, p = 0.01). The ORIF group had higher rates of postoperative transfusion (p = 0.002), return to OR (p = 0.005), and surgical site infection (SSI, p = 0.03). After multivariate analysis, ASA class 4, increasing age, increasing operative time, and history of bleeding disorder were found to increase the risk of AAE in both ORIF and IMN patients. CONCLUSIONS: While prior studies have claimed higher complication rates in IMN patients, this study found a significantly higher short-term risk of AAE in ORIF patients when compared in matched cohorts. However, individual 30-day complication rates do not differ significantly between procedures, and both have been shown to be safe and effective tools in the management of humeral shaft fractures.

Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures-A Prospective Cohort Study.

INTRODUCTION: Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. METHODS: This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. RESULTS: Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). CONCLUSION: Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. LEVEL OF EVIDENCE: Level II study: IRB approval-IRB#848938.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report.

BACKGROUND: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. CASE PRESENTATION: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient's elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. CONCLUSION: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

[Incorrectly healed supracondylar humerus fracture : That will grow out later on?!] / Fehlverheilte suprakondyläre Humerusfraktur : Das wächst sich schon noch aus?!

The supracondylar humerus fracture is the most frequent fracture of the elbow region during the growth period. The peak age is around 5 years. Extension fractures predominate. The clinical diagnostics are supplemented by X­ray images in two projections. Growth-associated spontaneous corrections of posttraumatic deformities rarely occur. The goal of treatment is therefore the active transformation of every displaced fracture into a nondisplaced stably fixed fracture.If this is not successful, the consequences of healing in a malalignment can be, e.g., restriction of elbow flexion due to remaining antecurvation or cubitus varus. Combinations are often present. The causes include technical problems with reduction and retention but also misjudgement of the X­ray findings, ignorance of the growth prognosis or inadequate verification of whether the treatment goal has been achieved.Unsatisfactory treatment results should be corrected as early as possible. This can be done primarily before bony healing is completed or secondarily as a corrective osteotomy at any later point in time. The earlier the correction of the malalignment is performed, the greater the chances of a complete restoration to the original condition. Depending on the type and extent of the deformity various techniques for corrective osteotomy are suggested in the literature.

Trends in reported outcomes and patient reported outcome measures (PROMs) in humeral shaft fracture literature: a systematic review.

PURPOSE: With a lack of standardization among outcome measures in fracture literature, cross-study comparisons remain limited. This systematic review aimed to identify trends in outcome measures reported by studies of the treatment of humeral shaft fractures. METHODS: A systematic review was performed of studies reporting clinical outcomes of humeral shaft fractures indexed in PubMed. Extracted data included demographics, fracture characteristics, treatment modalities, outcomes, patient reported outcome measures (PROMs), and journal characteristics. Cochran-Armitage tests and linear regressions were used to identify data trends. Pearson chi-square and Kruskal-Wallis tests were used for comparisons between studies. RESULTS: This review included 197 studies with outcomes of 15,445 humeral shaft fractures. 126 studies reported PROMs and 37 different PROMs were used. The Constant Score was most commonly reported (34% of studies), followed by ASES Score (21%), MEPS (21%), and DASH Score (20%). There was a significant increase in PROM usage over time (p = 0.016) and in articles using three or more PROMs (p = 0.005). The number of PROMs were significantly greater in prospective cohort studies and RCTs (p = 0.012) compared to retrospective cohort studies and case series (p = 0.044 for both). Post-treatment shoulder motion was reported in 43% of studies and 34% reported elbow motion. 86% of studies reported complications as an outcome parameter. Time to union and nonunion rate were published in 69% and 88% of studies, respectively. CONCLUSION: This study identified increasing PROM usage over time and disparities in the reporting of outcomes in humeral shaft fracture literature requiring further validation and standardization of available outcome measures.

Primary Reconstruction Using Fibular Strut Allograft for Distal Humerus Intra-articular Comminuted Open Fracture (AO/OTA13C2, G-A type IIIA): A Case Report.

Distal humerus intra-articular comminuted open fracture is a challenging injury, with nonunion, infection and stiffness considered as major concerns. We report a 58-year-old woman who was admitted to the emergency department from a car accident, sustaining an open wound with severe comminution of distal humerus and complete articular fracture, classified as AO/OTA 13C2 and Gustillo Anderson type IIIA. Debridement and external fixation was done first, followed by open reduction and internal fixation with fibular strut allograft. The patient showed excellent results in radiological and functional outcomes. Level of Evidence: Level V (Therapeutic).

Nonunion of distal humeral fractures: Current concepts.

The incidence of complex articular fractures of the distal humeral in adults has increased and will be growing in the future due to the greater incidence of high energy trauma and to the higher percentage of elderly population. Successful treatment is challenging for the needed balance between a stability of often comminuted fracture and early motion. Nonunion is a common complication after distal humerus fractures that is influenced by a variety of factors such as biology, in particular the blood supply of the metaphysis, the non-anatomical reduction of the fracture, the methods of fixation, and mechanical failure. These can involve the intra-articular or extra-articular areas. Clinical presentation may be mainly with a flail elbow in extra-articular nonunion or mainly with disfunction and stiffness for an intra-articular nonunion. However, the symptoms will depend on the degree of articular surfaces damage and the main localization of nonunion in the intra- and extra-articular region. The surgical treatment is usually required, being the non-operative treatment with a brace a reasonable option just for low-demand patients and with a high risk of complications. Despite a limited range of motion regained, the union rate achieved with internal fixation and bone grafting is substantially high.

[Application of external fixator combined with Kirschner wire fixation for oblique and comminuted distal humeral metaphyseal-diaphyseal junction fractures in children].

Objective: To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. Methods: A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. Results: All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. Conclusion: EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.

Intercondylar T-Type Distal Humerus Fracture in a 10-Year-Old: A Case Report.

CASE: A 10-year-old, postmenarchal girl presented to the emergency department with a closed, displaced, intercondylar T-type distal humerus fracture. Open reduction and internal fixation was performed 3 days following initial presentation. The patient healed but experienced elbow stiffness in the 7 months following the procedure. Implant removal and capsular release were performed at that time. At the 31-month follow-up, the patient reported satisfactory elbow functionality. CONCLUSION: There is limited literature available discussing optimal management and associated outcomes of intercondylar T-type distal humerus fractures in the young-adolescent population. This report presents a possible method for management of the initial injury and the most common associated complication.

Minimally invasive techniques utilizing the "Joy Stick" method for managing irreducible flexion-type supracondylar fractures of the humerus in older children.

OBJECTIVE: In this study, we investigated the efficacy of percutaneous poking reduction and Kirschner wire fixation in older children with irreducible supracondylar flexion-type fractures of the humerus. METHODS: This retrospective investigation included 27 children, comprising 15 males and 12 females, aged between 10 years and 3 months to 14 years and 11 months, all diagnosed with a flexion-type supracondylar fracture of the humerus within one week of trauma. All patients underwent surgery under general anesthesia. Following unsuccessful manual reduction, percutaneous poking reduction with Kirschner wires was performed under C-arm fluoroscopy to achieve fracture reduction. Following successful reduction, three 2.0 mm Kirschner wires were inserted in a cross pattern to secure the fracture ends. Postoperatively, the elbow joint was immobilized in a functional position with a plaster cast for four weeks. RESULTS: Follow-up in the outpatient department ranged from 9 to 36 months. Clinical functional assessment using Flynn's criteria rated 24 cases as excellent, 2 as good, and 1 as fair, yielding an overall efficacy of 96.3%. No cases of fracture re-displacement, fracture fragment necrosis, or other complications such as nonunion, iatrogenic nerve injury, myositis ossificans, or long-term elbow joint dysfunction were observed during the postoperative follow-up. CONCLUSION: The percutaneous poking reduction and Kirschner wire fixation technique is a simple and reliable procedure for treating irreducible flexion-type supracondylar fractures of the humerus in older children, with minimal trauma. This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function.