A case report: Distal humeral diaphyseal fracture in a child

Abstract

Rationale: Distal humeral diaphyseal fractures are much less common than supracondylar humeral fractures. The triangular shape and thinner periosteum in the diaphyseal region than in the supracondylar region of the distal diaphysis makes the treatment of diaphyseal fractures difficult. Nonoperative treatment for this fracture is challenging and troublesome; thus, open reduction and internal fixation (OR/IF) is generally recommended.

Patient concerns: We herein report a distal humeral diaphyseal fracture in a child. A 6-year-old boy fell from a chair, injuring his left elbow. Radiographs were performed at a local clinic.

Diagnosis: Unstable diaphyseal shaft fracture of the left humerus.

Interventions: Because of the severe displacement of the fracture and difficulty maintaining alignment for reduction, we performed OR/IF using an anterior mini-incision approach on the cubital skin line under general anesthesia.

Outcomes: Displacement of the fracture was reduced easily, and stable fixation was achieved using percutaneous intramedullary Kirschner wires. After immobilization with a long-arm cast for 4 weeks, the cast was removed and range-of-motion exercises were encouraged. At 9 months postoperatively, the range of elbow motion was 0° to 135°. Baumann angle and the carrying angle were 62° and 17°, respectively. According to Flynn criteria, the result was excellent.

Lessons: OR/IF using the herein-described cubital anterior approach seems to be a safe and easily performed procedure for distal humeral diaphyseal fractures, and percutaneous intramedullary Kirschner wires provide reliable fixation in such cases.

Figure 1

Preoperative roentgenogram of the left upper extremity. Radiographs showed severe displacement of the distal humeral diaphyseal fracture.

Figure 2

Preoperative (A) anteroposterior magnetic resonance image of the left upper extremity and (B) lateral magnetic resonance image of the left elbow. A vertical fracture line was seen extending into the lateral humeral condylar physis of the distal humerus.

Figure 3

Open reduction procedure. (A and B) The displacement of the fracture was easily reduced by open reduction using an anterior mini-incision and thumb compression.

Figure 4

Early postoperative roentgenograms of the left elbow. (A and B) Percutaneous intramedullary fixation provided stability of the distal humeral diaphyseal fracture.

Figure 5

Postoperative roentgenograms of the left elbow at 32 months postoperatively. (A and B) Radiographs showed adequate healing without any deformity of the elbow.

Figure 6

Postoperative photographs of left elbow at 32 months postoperatively. The range of motion was 0° to 135°, which was equal to the contralateral side. According to the Flynn criteria, this result was excellent. In addition, the surgical scar result was cosmetically excellent.