Pediatric distal humerus 13-M/3.2 III and IV

ESIN

ESIN

Main indication: Anatomical closed reduction of main fragments possible and need for earlier motion

Skill: Highly experienced and skilled surgeon
Equipment: Full specialized surgical and imaging resources

Indications

  • 13-M/3.2 III and IV fractures with minimal to moderate amounts of comminution, or impaction
  • Anatomical closed reduction of main fragments possible
  • Need for earlier motion without external support
  • Fractures that are reduced, but because of the fracture morphology (long oblique fracture plane), cannot be stabilized with K-wires (before considering open reduction)
  • Primary, or secondary, vascular problems, including perfused, but pulseless hand.
    NB: White pulseless hand, requires exploration
  • Revision of secondarily displaced, or imperfectly reduced, fractures, within 7 days of injury
  • Superficial skin lesions in the fracture region

Contraindications

  • Multifragmentary fractures that cannot be made stable in respect of length, or angulation, with nails
  • Inability to achieve anatomical reduction of main fracture fragments

Advantages

  • Cast or splint unnecessary
  • Radial and ulnar nerve irritation/damage avoided
  • Early functional rehabilitation
  • Rotationally stable

Disadvantages

  • Technically very demanding
  • Long learning curve
  • Time-consuming
  • Considerable radiation exposure
  • Risk of nail tip perforation into the joint
  • Second procedure required for nail removal
  • Normally requires two image intensifiers

Legend

*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

Appendix

Shortcuts

Contact | Disclaimer | AO Foundation

v1.0 2016-12-01