Can the reduction quality of distal humeral transphyseal fractures be determined using reference measurements on conventional radiography?

Abstract

Objective: Our objective was to compare the radiological outcomes of transphyseal fractures treated using closed reduction and percutaneous fixation, without arthrography, with those of supracondylar humerus fractures treated using the same method within a similar age group. Additionally, we aimed to assess the efficacy of the reference points in the lateral and anteroposterior radiographs utilized for the evaluation of reduction.

Patients and methods: The study included patients aged 0-3 years who underwent surgery for supracondylar and transphyseal fractures between 2013 and 2022. All the patients were diagnosed using anteroposterior (AP) and lateral elbow X-rays. No arthrographic intervention was used either in the diagnosis or treatment phase. On the AP X-rays, we assessed the alignment between the humeral shaft line and the ulnar long axis line to determine the positioning of the distal humeral physis segment in relation to the humerus. Additionally, we evaluated the relationship between the anterior cortex line of the humerus and the coronoid process on lateral radiographs. At the final follow-up visit, Flynn criteria were used for functional assessment.

Results: The study comprised 24 patients with supracondylar humerus fractures and 24 patients with transphyseal fractures. In the early post-operative radiographs, the humero-ulnar angle measured 6.43° (-7° - 16.6°) in the supracondylar group and 9.8° (-4.3° - 25.3°) in the transphyseal group (p = 0.087). The distance between the coronoid and the anterior humeral line was 9.19 mm (4.27 - 16.08) for the supracondylar fracture group and 8.05 mm (3.29 - 14.85) for the transphyseal fracture group (p = 0.513).

Conclusions: The current study's findings suggest that both the humero-ulnar angle and the distance between the coronoid and the anterior humeral line are valuable indicators for assessing the quality of reduction in transphyseal distal humerus fractures.