Annual Report

Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/4.1M

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Glossary

General considerations

The preferred treatment option for this fracture is an open approach and stable fixation.

In most cases it is possible to perform screw fixation. Only in the rare situation of a young child is K-wire fixation indicated.

Timing of treatment

Only severely displaced fractures with risk of secondary damage (eg, skin perforation by the pressure of the fragment) and open fractures are indications for emergency surgery.

There is evidence that in nonurgent cases a delay in treatment of up to 2-3 days has no negative effect on healing or outcome.

The following points influence the timing of the treatment:

  • Availability of surgical resources, including an experienced surgeon and cannulated screw equipment
  • The patient should be treated on a routine operating list, preferably the day after injury. In the meantime, plaster splint immobilization and elevation of the elbow joint is recommended for pain management
Cast immobilization
Main indication Skill Equipment
Undisplaced stable fractures Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Undisplaced stable fractures

Contraindications

  • Displaced fractures
  • Associated elbow joint instability

Advantages

  • No anesthesia
  • No open intervention

Disadvantages

  • Malunion or nonunion possible
Open reduction; screw fixation
Main indication Skill Equipment
Unstable, displaced fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Unstable, displaced fractures
  • Fragments that are big enough for screw fixation
  • Older children
  • Ulnar nerve deficit

Contraindications

  • Undisplaced fractures

Advantages

  • Safe and stable fixation if technique is precise
  • Uncomplicated healing
  • Anatomical reduction
  • Early mobilization (cast only for 1-2 weeks)
  • Prevention of ulnar nerve irritation

Disadvantages

  • Second intervention to remove the screw
  • Risk of iatrogenic ulnar nerve damage
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2016-12-01