[Descending intramedullary nailing for the treatment of displaced supracondylar humeral fractures in children].
BACKGROUND
Supracondylar humeral fractures are the most common lesions in childhood. Severely displaced fractures are commonly treated by crossed K-wire osteosynthesis. Such stabilized fractures require a cast and often involve postoperative complications such as iatrogenic lesions of the n. ulnaris and secondary displacements,sometimes leading to a consecutive cubitus varus. This study analyzed possible advantages of elastic stabile intramedullary nailing (ESIN) with postoperative release of motion.


METHODS
All children aged 1-14 years suffering from a supracondylar humeral fracture, with a displacement in at least two planes,were included in this study (period: 1 June 1999-30 April 2001). Movement was permitted for all patients postoperatively. A follow-up examination was scheduled at least 6 months after trauma.


RESULTS
This study included 20 female and 30 male patients. Neither iatrogenic lesions of the n. ulnaris nor secondary displacements occurred. Five slight technical pitfalls (perforating wire, gapping with consecutive axis deviation) occurred. Postoperative X-rays most often revealed a remaining axis deviation in the sagittal plane. Comminuted fractures with corresponding zones resulted in cubiti vari and valgi. Of the 50 patients, 47 appeared for follow-up (94%). The ROM coincided with the acquired radiological data. Only one patient (2%) showed a functional deficit greater than 10 degrees.


CONCLUSIONS
As soft tissue swelling does not hinder the surgeon, ESIN shows a high rate of closed stabilizations. No cast has to be applied and free ROM can be permitted for all patients. Avoidance of iatrogenic lesions of the n. ulnaris and secondary displacements are other advantages of this method.
Universitätsklinik für Kinderchirurgie der Universität Graz, Graz, Austria. annelie.weinberg@t-online.de
Annelie-M
AM
Weinberg
S
S
von  Bismarck
C
C
Castellani
J
J
Mayr
D000293:Adolescent; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012784:Shoulder Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D000092464:Elbow Injuries