Study of olecranon fractures in childhood and evaluation of the treatment approach.

During a 20 year period, 64 children with olecranon fractures were treated in our clinic. 51 children (41 males and 10 females) aged from to 2.5 to 14 years were reviewed. The follow up period was 1 to 20 years(average 9 years). Coexisting skeletal injury appeared in 31 patients. 36 children were treated conservatively while we follow operative treatment (open reduction and stabilization with Kirschner wires with or without tension-band or screws) in 15 children.

At the very last examination 2 children complained of mild pain during weather changes. Elbow extension was reduced from 5° to 15° in 6 patients and elbow flexion was reduced up to 5° in 3 patients. Pronation shortage was observed in 3 patients from 5° to 20° and a 10° supination shortage was observed in 1 patient. One case with pronation – supination shortage (40° and 70° respectively) while persisting subluxation of radial head was in 1 patient. The greatest degree of mobility limitation was observed in patients with comminuted fractures and associated injuries. Transient paresis of the radial nerve was observed in 1 patient.

The usual therapeutic approach to olecranon fractures is conservative.

In cases of displaced fractures, especially when the intraarticular displacement is greater than 3mm, surgical approach is indicated. Complications tend to occur more frequently among those cases with associated injuries. Olecranon paramorphosis in varus needs special attention since it usually coexists with radial head dislocation.

Introduction: This study examines the proximal tibial metaphyseal fractures in children and specifically the valgus deformity and leg overgrowth of the tibia.

Methods: We examined 27 children with proximal tibial metaphyseal fractures. Among them, 11 presented with greenstick fractures, 6 with complete, 5 with hairline, 3 with torus and 2 with stress fractures. The mean age was 7 years old (1–14). The average follow up period was 9.5 years. Fifteen children were below the age of 7 while 12 were between 8–14 years old. Twenty five patients were treated conservatively and 2 surgically.

Results: Valgus deformity occurred during the follow up period in 73% of the children aged below 7 y.o. and 17% of the older children. The higher values of valgus deformity ranged between 8–18 degrees and were observed at 10–18 months post-traumatically, especially in younger ages and after inadequate reductions. At the time of the final follow up examination, satisfactory spontaneous correction of the deformity, inversely proportional to age was observed in all cases. The degree of final valgus deformity ranged between 1–9 degrees. Overgrowth of the affected extremity was observed in 74% of the cases and ranged between 0, 4 and 1, 5 cm. Tibial overgrowth is not dependent to skeletal age. None of torus and stress fractures developed valgus deformity or longitudinal overgrowth. Compartment syndrome occurred in one case.

Conclusion: A high tendency to valgus deformity, especially in younger ages, was observed in proximal tibial metaphyseal fractures, even among undisplaced or surgically treated ones. Approximately two years post-traumatically, the beginning of a progressive spontaneous satisfactory correction of the deformity – inversely proportional to age – was noticed. It is worth mentioning that valgus deformity up to 10 degrees and tibial overgrowth up to 1, 5 cm cause no functional or cosmetic problems. The above observations prevent us from unnecessary surgical correction. Conservative treatment is preferred for the proximal tibial metaphyseal fractures. Operative treatment is indicated after inadequate reduction, especially in older children and after open fractures.