Outcome of Displaced Fractures of the Distal Metaphyseal-Diaphyseal Junction of the Humerus in Children Treated With Elastic Stable Intramedullary Nails.
BACKGROUND
The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced distal humeral metaphyseal-diaphyseal junction fractures in children treated by elastic stable intramedullary nailing (ESIN).


METHODS
During the study period, 14 consecutive children with fractures of the distal humeral metaphyseal-diaphyseal junction were surgically treated by ESIN. All patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus. One year after the index surgery, patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH).


RESULTS
During the study period, fractures of the distal metaphyseal-diaphyseal humeral junction represented 1.5% (16/1100) of all humeral fractures. Fourteen patients underwent surgery and met the inclusion criteria. The male to female ratio was 1:1. The average patient age at the time of injury was 9.7 years (range, 3.6 to 13.7 y). The left and right sides were equally affected. The mean follow-up was 28.1 months (range, 20 to 38 mo).Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, nonunion, or refracture was noted. None of the patients showed signs of growth arrest on either radiologic or clinical assessment.All patients returned to their previous daily and sport activities without discomfort or difficulty, and they were free of pain at their last follow-up visits. The injured elbow range of motion was comparable with that of the contralateral side at the last follow-up visit in all patients. The mean Quick DASH score was 0.81 (range, 0 to 6.8).


CONCLUSIONS
We recommend surgery for displaced fractures of the distal humeral metaphyseal-diaphyseal junction. ESIN results in stable reduction, good rotational control, and faster mobilization.


METHODS
Level IV.
*Pediatric Orthopedic Department, Regina Margherita Children's Hospital, Torino, Italy †Pediatric Orthopedic Department, University Hospital Estaing, Clermont-Ferrand, France ‡Pediatric Orthopedic Department, Bellinzona e Valli Regional Hospital, Bellinzona, Switzerland.
Lorenza
L
Marengo
Federico
F
Canavese
Mattia
M
Cravino
Vincenzo
V
De Rosa
Marie
M
Rousset
Antoine
A
Samba
Mounira
M
Mansour
Antonio
A
Andreacchio
D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries; D004551:Elbow Joint / Q000503:physiopathology; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000068958:Return to Sport; D011795:Surveys and Questionnaires; D016896:Treatment Outcome