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Evidence-Based Treatments of Paediatric Elbow Fractures

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Paediatric Orthopaedics

Abstract

Fractures around the elbow are common in children and account for a large proportion of both paediatric fracture clinics and paediatric trauma lists. Many of these injuries can be managed simply with good functional results; however, the potential for disabling consequences of these fractures remains and the broad spectrum of fracture variants and severities can continue to challenge experienced clinicians. In this chapter, we examined the evidence relating to the management of common fractures around the elbow in an attempt to answer some of the important clinical questions, as well as identify those that remain unresolved.

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References

  1. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998;18(1):38–42.

    CAS  PubMed  Google Scholar 

  2. Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough? Pediatr Emerg Care. 2012;28(11):1150–3.

    Article  PubMed  Google Scholar 

  3. Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1988;70(5):641–50.

    Article  CAS  PubMed  Google Scholar 

  4. Aitken AL. Supracondylar fractures in children. Am J Surg. 1943;59(2):161–71.

    Article  Google Scholar 

  5. Prietto CA. Supracondylar fractures of the humerus. A comparative study of Dunlop’s traction versus percutaneous pinning. J Bone Joint Surg Am. 1979;61(3):425–8.

    Article  CAS  PubMed  Google Scholar 

  6. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008;28(2):139–41.

    Article  PubMed  Google Scholar 

  7. Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, et al. The treatment of pediatric supracondylar humerus fractures. 2011; Available at: http://www.aaos.org/research/guidelines/SupracondylarFracture/SupConFullGuideline.pdf

  8. De Boeck H, De Smet P, Penders W, De Rydt D. Supracondylar elbow fractures with impaction of the medial condyle in children. J Pediatr Orthop. 1995;15(4):444–8.

    Article  CAS  PubMed  Google Scholar 

  9. Hamdi A, Poitras P, Louati H, Dagenais S, Masquijo JJ, Kontio K. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop. 2010 Mar;30(2):135–9.

    Google Scholar 

  10. Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am. 2007 Apr;89(4):706–12.

    Google Scholar 

  11. Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007;27(2):181–6.

    Article  PubMed  Google Scholar 

  12. Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in supracondylar fracture of the humerus in children. J Orthop Trauma. 2012;26(1):48–53.

    Article  PubMed  Google Scholar 

  13. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83-A(5):735–40.

    Article  CAS  PubMed  Google Scholar 

  14. Britisth Orthopaedic Association. Supracondylar fractures of the humerus in children. Boast 11 2014.

    Google Scholar 

  15. Ozkoc G, Gonc U, Kayaalp A, Teker K, Peker TT. Displaced supracondylar humeral fractures in children: open reduction vs. closed reduction and pinning. Arch Orthop Trauma Surg. 2004;124(8):547–51.

    Article  PubMed  Google Scholar 

  16. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am. 2001;83-A(3):323–7.

    Article  CAS  PubMed  Google Scholar 

  17. Carmichael KD, Joyner K. Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures. Orthopedics. 2006;29(7):628–32.

    PubMed  Google Scholar 

  18. Sibinski M, Sharma H, Bennet GC. Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children. J Bone Joint Surg Br. 2006;88(3):380–1.

    Article  CAS  PubMed  Google Scholar 

  19. Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br. 2006;88(4):528–30.

    Article  CAS  PubMed  Google Scholar 

  20. Schoenecker PL, Delgado E, Rotman M, Sicard GA, Capelli AM. Pulseless arm in association with totally displaced supracondylar fracture. J Orthop Trauma. 1996;10(6):410–5.

    Article  CAS  PubMed  Google Scholar 

  21. Garbuz DS, Leitch K, Wright JG. The treatment of supracondylar fractures in children with an absent radial pulse. J Pediatr Orthop. 1996;16(5):594–6.

    Article  CAS  PubMed  Google Scholar 

  22. Sabharwal S, Tredwell SJ, Beauchamp RD, Mackenzie WG, Jakubec DM, Cairns R, et al. Management of pulseless pink hand in pediatric supracondylar fractures of humerus. J Pediatr Orthop. 1997;17(3):303–10.

    CAS  PubMed  Google Scholar 

  23. Surgeons AA. Introductory packet for Clinical Practice Guidelines (CPG)/Systematic Review (SR Work Group Members. 2015; Available at: http://www.aaos.org/research/guidelines/InteractiveIntroPacket.pdf

  24. Warwick D, Dahl OE, Fisher WD. International surgical thrombosis forum. Orthopaedic thromboprophylaxis: limitations of current guidelines. J Bone Joint Surg Br. 2008;90(2):127–32.

    Article  CAS  PubMed  Google Scholar 

  25. Song KS, Kang CH, Min BW, Bae KC, Cho CH. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am. 2007;89(1):58–63.

    PubMed  Google Scholar 

  26. Horn BD, Herman MJ, Crisci K, Pizzutillo PD, MacEwen GD. Fractures of the lateral humeral condyle: role of the cartilage hinge in fracture stability. J Pediatr Orthop. 2002;22(1):8–11.

    PubMed  Google Scholar 

  27. Launay F, Leet AI, Jacopin S, Jouve JL, Bollini G, Sponseller PD. Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Pediatr Orthop. 2004;24(4):385–91.

    Article  PubMed  Google Scholar 

  28. Bast SC, Hoffer MM, Aval S. Nonoperative treatment for minimally and nondisplaced lateral humeral condyle fractures in children. J Pediatr Orthop. 1998;18(4):448–50.

    CAS  PubMed  Google Scholar 

  29. Bloom T, Chen LY, Sabharwal S. Biomechanical analysis of lateral humeral condyle fracture pinning. J Pediatr Orthop. 2011;31(2):130–7.

    Article  PubMed  Google Scholar 

  30. Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46(2):138–44.

    Google Scholar 

  31. Sharma H, Maheshwari R, Wilson N. Lateral humeral condyle fractures in children: a comparative cohort study on screws versus K-wires. J Bone Joint Surg Br. 2006;434.

    Google Scholar 

  32. Thomas DP, Howard AW, Cole WG, Hedden DM. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop. 2001;21(5):565–9.

    CAS  PubMed  Google Scholar 

  33. Vahvanen V, Gripenberg L. Fracture of the radial neck in children. A long-term follow-up study of 43 cases. Acta Orthop Scand. 1978;49(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  34. D’souza S, Vaishya R, Klenerman L. Management of radial neck fractures in children: a retrospective analysis of one hundred patients. J Pediatr Orthop. 1993;13(2):232–8.

    PubMed  Google Scholar 

  35. Falciglia F, Giordano M, Aulisa AG, Di Lazzaro A, Guzzanti V. Radial neck fractures in children: results when open reduction is indicated. J Pediatr Orthop. 2014;34(8):756–62.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Basmajian HG, Choi PD, Huh K, Sankar WN, Wells L, Arkader A. Radial neck fractures in children: experience from two level-1 trauma centers. J Pediatr Orthop B. 2014;23(4):369–74.

    Article  PubMed  Google Scholar 

  37. Steele JA, Graham HK. Angulated radial neck fractures in children. A prospective study of percutaneous reduction. J Bone Joint Surg Br. 1992;75(1):169.

    Google Scholar 

  38. Stiefel D, Meuli M, Altermatt S. Fractures of the neck of the radius in children. Early experience with intramedullary pinning. J Bone Joint Surg Br. 2001;83(4):536–41.

    Article  CAS  PubMed  Google Scholar 

  39. Schmittenbecher PP, Haevernick B, Herold A, Knorr P, Schmid E. Treatment decision, method of osteosynthesis, and outcome in radial neck fractures in children: a multicenter study. J Pediatr Orthop. 2005;25(1):45–50.

    PubMed  Google Scholar 

  40. Wang J, Chen W, Guo M, Su Y, Zhang Y. Percutaneous reduction and intramedullary fixation technique for displaced pediatric radial neck fractures. J Pediatr Orthop B. 2013;22(2):127–32.

    Article  CAS  PubMed  Google Scholar 

  41. Beaty JH. Operative treatment of femoral shaft fractures in children and adolescents. Clin Orthop Relat Res. 2005;434:114–22.

    Article  Google Scholar 

  42. Wilson NIL. Treatment of fractures of the medial epicondyle of the humerus. Injury. 1988;19(5):342–4.

    Article  CAS  PubMed  Google Scholar 

  43. Edmonds EW. How displaced are “nondisplaced” fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis. J Bone Joint Surg Am. 2010;92(17):2785–91.

    Article  PubMed  Google Scholar 

  44. Roberts N. Displacement of the internal epicondyle into the elbow-joint. The Lancet. 1934;224(5788):281.

    Article  Google Scholar 

  45. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001;83-A(9):1299–305.

    Article  CAS  PubMed  Google Scholar 

  46. Osbahr DC, Chalmers PN, Frank JS, Williams RJ3rd, Widmann RF, Green DW. Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: a variant of Little League elbow. J Shoulder Elbow Surg 2010;19(7):951-957.

    Google Scholar 

  47. Lawrence JT, Patel NM, Macknin J, Flynn JM, Cameron D, Wolfgruber HC, et al. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. Am J Sports Med. 2013;41(5):1152–7.

    Article  PubMed  Google Scholar 

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Correspondence to Emily J. Mounsey .

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Mounsey, E.J., Howard, A. (2017). Evidence-Based Treatments of Paediatric Elbow Fractures. In: Alshryda, S., Huntley, J., Banaszkiewicz, P. (eds) Paediatric Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-41142-2_32

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  • DOI: https://doi.org/10.1007/978-3-319-41142-2_32

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