Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation

Xinwu Wu; Linkun Wu; Federico Canavese; Dianhua Huang; Shunyou Chen

doi:10.1177/18632521241246142

Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation

J Child Orthop. 2024 Apr 29:18632521241246142. doi: 10.1177/18632521241246142. Online ahead of print.

Authors

Xinwu Wu^{1

2

3}, Linkun Wu⁴, Federico Canavese⁵, Dianhua Huang^{1

2

3}, Shunyou Chen^{1

4}

Affiliations

¹ Department of Orthopedics, Fuzhou Second General Hospital, Fuzhou, P.R. China.
² Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, P.R. China.
³ Fuzhou Trauma Medical Center, Fuzhou, P.R. China.
⁴ Fujian University of Traditional Chinese Medicine, Fuzhou, P.R. China.
⁵ Department of Pediatric Orthopedic Surgery, Lille University Center and Henri Warembourg Faculty of Medicine, Jeanne de Flandre Hospital, Lille, France.

Abstract

Background: Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to evaluate outcomes in the management of fracture separation of the distal humeral epiphysis treated seven or more days post-initial injury.

Methods: A retrospective analysis was conducted on patients diagnosed with fracture separation of the distal humeral epiphysis between November 2016 and October 2023. Inclusion criteria encompassed patients with delayed presentation of fracture separation of the distal humeral epiphysis who underwent surgical intervention seven or more days following the initial injury. Demographic data were collected, and fractures were categorized using the modified DeLee classification. Plain radiographs facilitated the assessment of the carrying angle and postoperative Baumann angle. Clinical outcomes were evaluated using the Flynn criteria.

Results: The study included 12 patients who met the inclusion criteria. The average age at the time of injury was 1.59 years. According to the modified DeLee system, fracture classification identified one type I fracture, eight type II fractures, and three type III fractures. The average duration from injury to surgery was 11.8 days. The mean surgical duration was 21.5 min. The average follow-up period was 40.7 months. One patient exhibited cubitus varus development. Based on the Flynn criteria, outcomes were as follows: seven patients had excellent outcomes, four had good outcomes, and one had a poor outcome.

Conclusion: Closed reduction with percutaneous K-wire fixation represents a minimally invasive approach suitable for children diagnosed with fracture separation of the distal humeral epiphysis seven or more days post-initial injury. Most of these patients experienced favorable outcomes.

Level of evidence: IV.

Keywords: Fracture separation of the distal humeral epiphysis; closed reduction; delayed treatment; outcome; percutaneous fixation; transphyseal elbow fracture.