Application of external fixator combined with Kirschner wire fixation for oblique and comminuted distal humeral metaphyseal-diaphyseal junction fractures in children
Objective To analyze the effectiveness of external fixator combined with Kirschner wire(EF-KW)fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction(DHMDJ)fractures in children.Methods A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed.All patients were treated with EF-KW fixation.There were 14 boys and 8 girls with an average age of 6.8 years(range,1.5-12.0 years).The time from injury to operation was 14-38 hours(mean,24.2 hours).There were 18 cases of comminuted fractures and 4 cases of oblique fractures;and 1 case of median nerve injury and 1 case of radial nerve injury before operation.The occurrence of postoperative complications was recorded.At last follow-up,the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score,and the Baumann's angle(BA)and humero-capitellar angle(HCA)of the affected and healthy sides were recorded and compared.Results All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred.Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment.The incisions of other patients healed by first intention.All patients were followed up 9-24 months(mean,13.8 months).At last follow-up,according to the Mayo elbow joint function score,the elbow joint function was rated as excellent in 15 cases,good in 6 cases,and fair in 1 case,with an excellent and good rate of 95.5％.The neurologic injury before operation recovered gradually.X-ray films reexamination showed that all fractures healed,and the healing time of fractures ranged from 29 to 61 days,with an average of 35.6 days.At last follow-up,there was no significant difference in BA and HCA between the healthy side and the affected side(P＞0.05).During follow-up,1 case developed mild cubitus varus,while the other patients had no serious complications.Conclusion EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma,simple operation,easy reduction,good stability after reduction,low incidence of serious complications,and good elbow functional recovery.
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