DELAYED TREATMENT OF SUPRA-, TRANS-, AND INTER-CONDYLAR FRACTURES OF THE DISTAL HUMERUS USING CLOSED REDUCTION AND EXTERNAL FIXATION

Abstract

Early percutaneous pin fixation after closed reduction is the treatment of choice for displaced distal humerus fractures.

Our purpose was to study the outcome of closed reduction and external fixation more than 1 week after injury.

Material and methods: Ninety-one children with fractures of the distal humerus were treated more than 7 days after injury (range 7 – 65 days, average 10,5 days). The average age at the time of surgery was 6,7 years (range 3,3 – 16,1years). 63 were male. All had 1–3 previous unsuccessful closed or\and open reductions in another clinic. Twelve had iatrogenic nerve injury. Our method consists of applying the Ilizarov’ apparatus in the proximal humerus for primary transolecranon traction and close reduction using image intensifier. After reduction two crossed K-wires were passed through the condyles and final fixator was constructed. The K-wire from olecranon was removed. Postoperative fixation was done for 3 – 6 weeks. Elbow motion was started 2–3 days after surgery.

Results: The results depended on the severity of the fracture and time after injury. All fractures went on to union. Good and excellent results (no deformity or contracture) occurred in 95 % of 59 patients with transcondylar fractures (AO classification type A2 and A3) and 7–16 days after injury. Of twenty patients with transcondylar fractures (AO classification A2 and A3) and more than 17 days 85% had similar result. Three children required eventual supracondylar osteotomy because of progressive rotational-varus deformity. Of twelve children with T- of Y- fractures (AO C1, C2, or C3) three (25%) had poor Results: Conclusion: Late reduction with external fixation was accomplished with anatomic reduction and good functional outcome and allowed early motion of the elbow.