scholarly journals Cast immobilisation in situ versus open reduction and internal fixation of displaced medial epicondyle fractures in children between 7 and 16 years old. A study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044627
Author(s):  
Tero Hämäläinen ◽  
Matti Ahonen ◽  
Ilkka Helenius ◽  
Jenni Jalkanen ◽  
Markus Lastikka ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ulnar Nerve ◽  
Operative Treatment ◽  
Open Reduction ◽  
Nonoperative Treatment ◽  
Medial Epicondyle ◽  
University Hospital ◽  
Fractures In Children ◽  
Patient Reported ◽  
Nerve Dysfunction

IntroductionMedial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation ≤2 mm) can be treated nonoperatively with immobilisation. Open fractures, fractures with joint incarceration or ulnar nerve dysfunction require surgery. There is no common consensus in treatment of closed medial epicondyle fractures with >2 mm dislocation without joint incarceration or ulnar nerve dysfunction. We hypothesise that there is no difference in treatment outcomes between nonoperative and operative treatment.Methods and analysisThis is a multicentre, controlled, prospective, randomised noninferiority study comparing operative treatment to non-operative treatment of >2 mm dislocated paediatric medial epicondyle fractures without joint incarceration or ulnar nerve dysfunction. A total of 120 patients will be randomised in 1:1 ratio to either operative or nonoperative treatment. The study will have a parallel nonrandomised patient preference arm. Operative treatment will be open reduction and internal fixation. Nonoperative treatment will be upper limb immobilisation in long arm cast for 4 weeks. Data will be collected at baseline and at each follow-up up to 2 years. Quick-DASH is used as primary outcome measure. Secondary outcomes are patient-reported pain, differences in range of motion, Pediatric Quality of Life Inventory, cosmetic visual analogue scale and Mayo Elbow Performance Score.Ethics and disseminationEthical approval has been obtained from Helsinki University Hospital (HUS) ethical board HUS/1443/2019. Each study centre has obtained their own permission for the study. A written authorisation from legal guardian will be acquired and the child will be informed about the trial. Results of the trial will be disseminated as published articles in peer-reviewed journals.Trial registrationThe trial has been registered at clinicaltrials.gov with registration number NCT04531085.

scholarly journals OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION OF DISPLACED MEDIAL EPICONDYLE HUMERUS FRACTURES IN CHILDREN

1969 ◽  
Vol 5 (1) ◽  
pp. 630-634
Author(s):  
WAQAR ALAM ◽  
DILAWAR KHAN ◽  
MUHAMMAD IDREES ◽  
FAIZ ALI SHAH ◽  
SHAMS UR REHMAN ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Teaching Hospital ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Medial Epicondyle ◽  
Elbow Fracture ◽  
Fractures In Children ◽  
Humerus Fractures

BACKGROUND: Medical epicondyle fracture is one of the commonest elbow fracture in children.Various treatment options exist inadequate treatment leads to elbow deformity. Our study will highlightone treatment option with open reduction and fixation with k-wires or one screw and one k-wire.OBJECTIVE: To determine the functional outcome of open reduction and internal fixation ofdisplaced medial epicondyle humerus fractures in children.MATERIAL AND METHODS: This Descriptive cross sectional study was conducted simultaneouslyat five orthopaedic units: Orthopaedic Unit District Headquarter Hospital Timergara Lower Dir,Orthopaedic Unit, Saidu Teaching Hospital Swat, Department of Orthopaedics and Trauma Khalifa GulNawaz Teaching Hospital Bannu, Orthopaedics and Traumatology Unit “ A” Lady Reading HospitalPeshawar and Department of Orthopaedics and Trauma, Pak International Medical College Peshawarfrom January 2012 to September 2014. Twenty one children meeting the inclusion criteria were operatedunder general anaesthesia and tourniquet control and fracture was stabilized with either two kirschnerwires or a screw and single kirschner wire. All patients were discharged on first or second postoperativeday and advised active movements of fingers. Patients were called for follow up visit after two, six andtwelve weeks and elbow functions and deformity was evaluated in each visit using modified criteria ofHardacre et al (25).RESULTS: Twenty one patients including 14 males and 7 females with mean age 12.3 years (range 6 to15 years) had displaced fracture of medial epicondyle and were operated. Two of our patients were lostin follow up and they were excluded from the final results. After evaluating our results according tomodified Hardacre et al criteria, five patients (26.32%) had excellent results, eleven (57.89%) patientshad good results and three (15.78%) patients had poor results.CONCLUSION: Early surgical stabilization of displace medial epicondyle humerus fractures inchildren results in excellent and good functional outcome in majority of patients.KEY WORDS: Medial epicondyle humerus, Open reduction and internal fixation, Kirschner wire.

Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures in Children

Orthopedics ◽  
2012 ◽  
Vol 35 (6) ◽  
pp. e874-e879 ◽  
Author(s):  
Guang-rong Yu ◽  
Hong-mou Zhao ◽  
Yun-feng Yang ◽  
Jia-qian Zhou ◽  
Hai-feng Li
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Calcaneal Fractures ◽  
Fractures In Children

scholarly journals Intra-articular displacement of an avulsed medial (internal) epicondyle ossification centre in the paediatric elbow: a radiographic finding not to be missed

2019 ◽  
Vol 12 (11) ◽  
pp. e231635
Author(s):  
Amir Qadeer ◽  
Michael Paddock
Keyword(s):  
Emergency Department ◽  
Internal Fixation ◽  
Open Reduction ◽  
Radiographic Finding ◽  
Medial Epicondyle ◽  
Ossification Centre ◽  
Elbow Pain

We present the case of an 11-year-old girl who was presented to the Emergency Department with right elbow pain and swelling following a fall. Radiography demonstrated intra-articular displacement of an avulsed medial epicondyle ossification centre, which was not readily identified at presentation. She proceeded to an uncomplicated open reduction and internal fixation.

scholarly journals The role of ulnar nerve subcutaneous anterior transposition during open reduction and internal fixation of distal humerus fractures: a retrospective cohort study

2020 ◽  
Vol 44 (12) ◽  
pp. 2701-2708 ◽  
Author(s):  
Abdulaziz F. Ahmed ◽  
Ashik Mohsin Parambathkandi ◽  
Wai Jing Geraldine Kong ◽  
Motasem Salameh ◽  
Aiman Mudawi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Internal Fixation ◽  
Ulnar Nerve ◽  
Retrospective Cohort Study ◽  
Open Reduction ◽  
Retrospective Cohort ◽  
Distal Humerus ◽  
Anterior Transposition ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Abstract Purpose To compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures. Methods This was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery. Results Twenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00). Conclusion We do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.

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