Annual Report

Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/8.1

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Glossary

General considerations

These are displaced intraarticular fractures and the fragment should be either repaired or excised to restore joint function.

Timing of treatment

These fractures do not require emergency surgery.

The following points influence the timing of the treatment:

  • Availability of surgical resources
  • The patient should be treated on a routine operating list, preferably on the day after injury. In the meantime, plaster splint immobilization and elevation of the elbow joint is recommended for pain
Arthrotomy and excision
Main indication Skill Equipment
Fragments too small for fixation Some specialized surgical experience Basic equipment only

Indications

  • Fragments that are too small for fixation

Contraindications

  • Large fragments

Advantages

  • One step procedure
  • Can be performed by mini-arthrotomy, or arthroscopy

Disadvantages

  • Joint cartilage defect, which will be replaced by fibrocartilage

Note: In a nonweight-bearing joint, such as the elbow joint, somewhat larger surface damage has a lower risk of degenerative joint disease.

Open reduction; screw fixation
Main indication Skill Equipment
Large osteochondral fragments Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Large osteochondral fragments (ie, frontal fracture of the capitellum [chisel fracture])

Contraindications

  • Isolated chondral fractures
  • Small osteochondral fractures

Advantages

  • Stable anatomical fixation
  • Functional postoperative management
  • Preservation of the joint surface

Disadvantages

  • Prominent screw head
  • Screw removal
*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