[Radiographic and clinical assessment of supracondylar humeral fractures resulted from sports in children]

Abstract

Objective: To investigate the radiographic and clinical assessment for supracondylar humeral fractures resulted from sports in children. Methods: The medical records of 166 patients with displaced supracondylar humerus fractures treated in Shengjing Hospital of China Medical University from January 2015 to December 2015 were reviewed.The etiology of 56 of 166 cases was relevant to the sports.Medical records of 56 of 166 patients were reviewed, incluidng gender, the mean age of patient at the time of surgery, the mean duration of injury, radiographic assessment based on the anteroposterior (AP) and lateral radiographs of the elbow, neurologic injury, the Mayo Elbow Performance Score (MEPS) and the criteria of Flynn. Results: There were 34 boys (34 elbows, 60.7% (34/56)) and 22 girls (22 elbows, 39.3% (22/56)), and 32 patients in left elbow (57.1% (32/56)) and 24 patients in right elbow(42.9% (24/56)). The etiology included football in 16 patients (28.6% (16/56)), basketball in 10 patients (17.9% (10/56)), skating in 10 patients (17.9% (10/56)), skiing in 8 patients (14.3% (8/56)), roller skating in 5 patients (8.8% (5/56)), kick scooter in 3 patients (5.3% (3/56)), riding horse in 2 patients (3.6% (2/56)) and horizontal bar in 2 patients (3.6% (2/56)). The mean age of 56 patients at the time of surgery was 9.5 years ( range from 6 to 13 years). The mean duration of injury was 2.2 days (range from 4 hours to 35 days). The AP and lateral radiographs of the elbow of all 56 patients (56 elbows) were performed, and three dimensional computed tomography(CT) were performed in 23 patients (23 elbows). There were 54 patients in extension type(96.4% (54/56)) and 2 cases in flexion type (3.6% (2/56)) of supracondylar humeral fractures. There were 20 patients (35.7% (20/56)) of Gartland type Ⅱ and 34 patients (60.7% (34/56)) of Gartland type Ⅲ in 54 patients of extension-type. Two cases of flexion type were both Gartland type Ⅱ (3.6% (2/56)). 33 patients (58.9% (33/56)) had posteromedial displacement of the distal fragment, 21 patients (37.5% (21/56)) had posterolateral displacement of the distal fragment, and 2 patients (3.6% (2/56)) had anterolateral displacement of the distal fragment. Three dimensional CT showed the "-" shape and apposite "V" shape in the anterio edge of proximal fragments in 21 patients (91.3% (21/23)) and 2 patients (8.7% (2/23)), respectively.CT showed Gartland type Ⅲ in 5 patients those AP and lateral radiographs of the elbows were Gartland type Ⅱ.The neurologic deficit of radial nerve injury in 2 patients (3.6% (2/56)) resulted from displaced distal fragment.Closed reduction and percutaneous pinning were performed in all 56 patients.The pin configuration included two or three parallel lateral pins in 46 patients (82.1% (46/56)) and two or three divergent lateral pins in 10 patients (17.9% (10/56)). Of the 56 patients, 7 patients were lost to follow-up, leaving a follow-up rate of 87.5% (49/56). The mean length of follow-up was 9.6 months (range from 4 to 14 months). There were no cases of Volkmann's ischaemic contracture, or iatrogenic injury of nerve.There were 25 excellent (44.6% (25/56)), 19 good (33.9% (19/56)), 10 fair results (17.9% (10/56)) and 2 poor results (3.6% (2/56)); the rate of excellent and good outcome was 78.5% (44/56) according to the criteria of Flynn.There were 47 excellent (83.9% (47/56)), 4 good (7.1% (4/56)) and 4 fair results (7.1% (4/56)) and 1 poor result (1.9% (1/56)), and the rate of excellent and good outcome was 91.0% (51/56) according to the MEPS. Conclusions: Sports is the common reason of supracondylar humeral fracture requiring surgical treatment in children.CT is valuable for the diagnosis of supracondylar humeral fracture.Good functional results in the short-term follow-up can be found after closed reduction and percutaneous lateral-entry pinning.

Keywords: Athletic injuries; Humeral fractures; Tomography, X-ray computed.