[Operative procedures for intraarticular distal humerus fractures in children and adolescents].

OBJECTIVE

Anatomic reduction and fragment fixation with Kirschner wires or screw osteosynthesis. Full range of motion and avoidance of growth disturbance.

INDICATIONS: All displaced and secondary displaced fractures.

CONTRAINDICATIONS: Screw osteosynthesis in small metaphyseal fragments; no contraindications for Kirschner wires.

SURGICAL TECHNIQUE: After open reduction, osteosynthesis in adequately sized metaphyseal fragment is performed with a 4-mm cancellous lag screw or, alternatively, with Kirschner wire pinning. The Kirschner wires penetrate the opposite cortex and are shortened under skin level. To increase the stability, it is possible to place a lag screw or Kirschner wire through the epiphysis, parallel to the physis. In barely displaced fractures, closed reduction and percutaneous pinning are possible.

POSTOPERATIVE MANAGEMENT: Postoperative immobilization in a long arm cast for 2-4 weeks, in stable lag screw osteosynthesis exercise out of a splint. If proper mobilization of the elbow cannot be achieved 3-4 weeks after cast removal, physiotherapy is required.

RESULTS

Good results with full physical activity are obtained after precise reduction and stable fixation of intraarticular fractures of the distal humerus. To achieve full range of motion and avoid growth disturbance, it is necessary to perform a stable osteosynthesis.