Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHI Qiang ¹ , YAN Hua ² , LI Xu ²

1. Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China;
2. Department of Pediatric Orthopaedics, Guangzhou Huaxin Orthopaedic Hospital, Shantou University, Guangzhou Guangdong, 510507, P.R.China;

Corresponding author：

SHI Qiang, Email: shiqiang2018@csu.edu.cn

Keywords：

Infant; elbow fracture; arthrography; lateral approach

DOI：

10.7507/1002-1892.202006085

Video：

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Objective To evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.Methods The clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used.Results None of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation (t=22.670, P=0.000; t=11.910, P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%.Conclusion Elbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.

Citation： SHI Qiang, YAN Hua, LI Xu. Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 82-85. doi: 10.7507/1002-1892.202006085 Copy

1.	Mitchell WJ, Adams JP. Supracondylar fractures of the humerus in children: a ten years review. JAMA, 1961, 175: 573-577.
2.	韩炳强, 张网林, 蔡海清, 等. 肘关节造影在 6 岁以下儿童严重桡骨颈骨折治疗中的应用. 中华手外科杂志, 2019, 35(2): 93-96.
3.	李敏, 孟海亮, 苏菲, 等. 关节造影辅助治疗儿童骨折移位≤2 mm肱骨外髁骨折. 中华创伤骨科杂志, 2018, 20(9): 803-805.
4.	Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
5.	Haillotte G, Bachy M, Delpont M, et al. The use of magnetic resonance imaging in management of minimally displaced or nondisplaced lateral humeral condyle fractures in children. Pediatr Emerg Care, 2017, 33(1): 21-25.
6.	Nowicki PD, Duhn R. The use of arthrography in pediatric orthopaedic surgery. J Am Acad Orthop Surg, 2014, 22(8): 472-481.
7.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
8.	Yates C, Sullivan JA. Arthrographic diagnosis of elbow injuries in children. J Pediatr Orthop, 1987, 7(1): 54-60.
9.	沈先涛, 陈小亮, 李雄涛, 等. B 型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折. 中华小儿外科杂志, 2015, 36(5): 363-367.
10.	姜海, 王晓威, 苗武胜, 等. 术中关节造影辅助治疗儿童肱骨远端骨骺分离骨折. 中华小儿外科杂志, 2017, 38(5): 340-343.
11.	米热阿迪力·努尔买买提, 冯力, 廖云杰, 等. 关节造影辅助下克氏针固定治疗儿童 JakobⅡ型肱骨外髁骨折. 中华手外科杂志, 2020, 36(2): 134-136.
12.	Basmajian HG, Choi PD, Huh K, et al. Radial neck fractures in children: experience from two level-1 trauma centers. J Pediatr Orthop B, 2014, 23(4): 369-374.
13.	Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Métaizeau technique. Injury, 2012, 43(3): 301-305.

1. Mitchell WJ, Adams JP. Supracondylar fractures of the humerus in children: a ten years review. JAMA, 1961, 175: 573-577.
2. 韩炳强, 张网林, 蔡海清, 等. 肘关节造影在 6 岁以下儿童严重桡骨颈骨折治疗中的应用. 中华手外科杂志, 2019, 35(2): 93-96.
3. 李敏, 孟海亮, 苏菲, 等. 关节造影辅助治疗儿童骨折移位≤2 mm肱骨外髁骨折. 中华创伤骨科杂志, 2018, 20(9): 803-805.
4. Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
5. Haillotte G, Bachy M, Delpont M, et al. The use of magnetic resonance imaging in management of minimally displaced or nondisplaced lateral humeral condyle fractures in children. Pediatr Emerg Care, 2017, 33(1): 21-25.
6. Nowicki PD, Duhn R. The use of arthrography in pediatric orthopaedic surgery. J Am Acad Orthop Surg, 2014, 22(8): 472-481.
7. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
8. Yates C, Sullivan JA. Arthrographic diagnosis of elbow injuries in children. J Pediatr Orthop, 1987, 7(1): 54-60.
9. 沈先涛, 陈小亮, 李雄涛, 等. B 型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折. 中华小儿外科杂志, 2015, 36(5): 363-367.
10. 姜海, 王晓威, 苗武胜, 等. 术中关节造影辅助治疗儿童肱骨远端骨骺分离骨折. 中华小儿外科杂志, 2017, 38(5): 340-343.
11. 米热阿迪力·努尔买买提, 冯力, 廖云杰, 等. 关节造影辅助下克氏针固定治疗儿童 JakobⅡ型肱骨外髁骨折. 中华手外科杂志, 2020, 36(2): 134-136.
12. Basmajian HG, Choi PD, Huh K, et al. Radial neck fractures in children: experience from two level-1 trauma centers. J Pediatr Orthop B, 2014, 23(4): 369-374.
13. Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Métaizeau technique. Injury, 2012, 43(3): 301-305.

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