Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus

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Glossary

13-M/3.1 I - Simple, incomplete, nondisplaced

Please select a treatment option:
Treatment Main indication Skill Equipment
Collar and cuff immobilization Any 13-M/3.1 I fracture Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Any 13-M/3.1 I fracture Basic surgical experience, no specialized skills Basic equipment only

13-M/3.1 II - Simple, incomplete, displaced

Please select a treatment option:
Treatment Main indication Skill Equipment
Collar and cuff immobilization Displaced, incomplete extension fractures, without varus deformity Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization (without reduction) Displaced, incomplete extension fractures, without varus deformity Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; splint immobilization Displaced, incomplete extension fractures, without varus deformity Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Any 13-M/3.1 II fracture Some specialized surgical experience Simple surgical and imaging resources

13-M/3.1 III and IV - Simple, complete with/without contact between fracture planes

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint immobilization Temporary immobilization whilst awaiting definitive treatment Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Any 13-M/3.1 III & IV fracture that can be reduced anatomically Some specialized surgical experience Full specialized surgical and imaging resources
Open reduction; K-wire fixation Any 13-M/3.1 III and IV fracture that cannot be reduced anatomically Some specialized surgical experience Simple surgical and imaging resources
External fixator Difficulty in obtaining closed anatomical reduction Some specialized surgical experience Simple surgical and imaging resources
ESIN Anatomical closed reduction achievable and requirement for early motion Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Olecranon screw traction Any 13-M/3.1 III & IV fracture that cannot be reduced anatomically Basic surgical experience, no specialized skills Basic equipment only

13-M/3.2 III and IV - Multifragmentary, complete with/without contact between fracture planes

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; K-wire fixation 13-M/3.2 III & IV fractures with minimal to moderate amounts of comminution Some specialized surgical experience Simple surgical and imaging resources
External fixator Multifragmentary fractures that are unstable (length or angulation) with K-wires alone Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Anatomical closed reduction of main fragments possible and need for earlier motion Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Olecranon screw traction Inability to obtain closed reduction and/or inability to obtain stable pin pattern Basic surgical experience, no specialized skills Basic equipment only
Open reduction; internal fixation Irreducible fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

13-M/7M - Avulsion of the epicondyle (extraarticular)

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint immobilization Undisplaced and minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
Closed elbow reduction; splint immobilization Uncomplicated reduction of elbow dislocation Basic surgical experience, no specialized skills Basic equipment only
Open epicondylar reduction and internal fixation Fragment entrapped in joint Some specialized surgical experience Basic equipment only

13-E/1.1 - Simple epiphysiolysis, SH I

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint immobilization Undisplaced stable fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Displaced and unstable fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

13-E/2.1 - Simple epiphysiolysis with metaphyseal wedge, SH II

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint immobilization Undisplaced stable fractures, early callus visible Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Displaced and unstable fractures Basic surgical experience, no specialized skills Simple surgical and imaging resources

13-E/3.1 - Simple epiphyseal, SH III

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast immobilization Undisplaced and stable on initial arthrography Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Fractures with a readily discernable gap, or step Some specialized surgical experience Simple surgical and imaging resources

13-E/4.1L - Simple epi-/metaphyseal, lateral condyle, SH IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast immobilization Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only
Closed indirect reduction, K-wire fixation Minimally displaced fractures Some specialized surgical experience Simple surgical and imaging resources
Minimally invasive cannulated screw fixation Minimally displaced fractures Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; K-wire fixation Small, displaced metaphyseal fragments Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; screw fixation Sizeable, displaced metaphyseal fragments Highly experienced and skilled surgeon Simple surgical and imaging resources

13-E/4.1M - Simple epi-/metaphyseal, medial condyle, SH IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast immobilization Undisplaced stable fractures Basic surgical experience, no specialized skills Basic equipment only
Open reduction; screw fixation Unstable, displaced fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

13-E/4.2 - Multifragmentary epi-/metaphyseal, SH IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction; screw and K-wire fixation Comminuted fractures Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; screw and plate fixation No comminution; less mature children Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; screw and external fixator Contaminated, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

13-E/7L - Avulsion of/by the collateral ligament

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast immobilization Undisplaced and stable fragments Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Postreduction elbow instability Some specialized surgical experience Simple surgical and imaging resources
Open reduction; screw fixation Postreduction elbow instability Some specialized surgical experience Simple surgical and imaging resources
Open reduction; suture or suture and anchor fixation Postreduction instability of the elbow Some specialized surgical experience Full specialized surgical and imaging resources

13-E/8.1 - Simple intraarticular flake

Please select a treatment option:
Treatment Main indication Skill Equipment
Arthrotomy and excision Fragments too small for fixation Some specialized surgical experience Basic equipment only
Open reduction; screw fixation Large osteochondral fragments Highly experienced and skilled surgeon Simple surgical and imaging resources
*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