Khudiev V. M.

ASPECTS OF RECONSTRUCTIVE OSTEOSYNTHESIS OF SUPRA AND TRANSCONDYLAR HUMERAL FRACTURES IN CHILDREN AFTER CLOSED REDUCTION


About the author:

Khudiev V. M.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scentific article

Annotation:

Objective: to analyze the condition of the elbow joint by the nature of the injury in various methods of treatment, to study the outcomes of treatment of supra- and transcondylar humeral fractures in children. Methods. We observed 155 children aged from 1 year to 15 years with supra- and transcondylar humeral fractures in children. Of these, there were 107 boys (69%), 48 girls (31%). In children’s traumatology Department of NIITO received treatment (107) and in BSMP (48) patients. In children from 4 to 7 years, elbow fractures occurred in 40% (62 children), which is associated with the beginning of active games at this age. Closed reposition with osteosynthesis with the spokes of Kirsner was used in 33 (21,3%) patients, of whom 13 (8,4%) were creamydinkly, and 9 (5,8%) names array, of these, 8 (5,2%) extensor, at 3 (1,9%) flexion fracture. After a closed reposition, these patients were injected with Kirshner spokes. When establishing the diagnosis, the whole complex of clinical signs in their totality should be taken into account. 50% of patients admitted to the Department of pediatric traumatology had severe swelling in the elbow joint, hematoma of the anterior surface of the joint. Neurological symptoms were noted in 7 (4.5%) patients, of which 3 were (1.9%) damaged radial nerve, median nerve – 1 in (0.75%), ulnar nerves in 3 (1.9%). Supra and transcondylar extensor fractures were in 67 (43.2%), flexor fractures in 88 (56.8%). Results. Supra and transcondylar fractures of the humerus in children are more common at the age of 8 to 10 years. In boys, these fractures are 2.2 times more common than in girls. With large swelling in the joint, two spokes were used in 98 patients, three spokes were used in 55 patients, one spoke was used in 1 patient, one cannulated screw was used in 1 (0.6%). From the mixing of fragments of the distal end, the fracture line and the method of treatment, it can be seen that of the 19 patients with closed reposition, 6 (3.9%) had TRANS-condylar, 3 (1.9%) supramondylar fractures, 7 (4.5%) extensor, and 3 patients (1.9%) had flexor fractures. Given that these fractures are simple intra-articular and the fracture line is on the same projection. Skeletal traction was used in 62 patients, 21 of them (13.5%) with a TRANS-condylar fracture, 12 (7.7%) with a suprasondylar fracture, 19 of them (12.3%) had an extensor fracture, and 10 patients had a flexor fracture (6.5%). Closed repositions with osteosynthesis of Kishner spokes were given in 33 patients (21.3%), of which 13 (8.4%) were TRANS-condylar, 9 – and suprasondylar (5.8%), and 8 – and extensor (5.2%), 3 patients with flexor fracture (1.9%). In this case, we used 33 patients (21.3%), of which 4 (2.6%) had a good result, 20 (12.9%) satisfactory, 9 (5.8%) unsatisfactory. Conclusion. Timely stable fixation leads to the restoration of the anatomical structure of the joint, to prevent secondary displacement.

Tags:

humerus, children, above and beyond condyles fractures, clinic, diagnostics.

Bibliography:

  1. Ahundov AA, Bajarinova MV, Ovsjankin NA. Neblagoprijatnye posledstvija neustranennogo smeshhenija otlomkov pri perelomah v oblasti loktevogo sustava u detej. Vseross. sezd travmat. ortoped. L.: 1973. s. 236-7. [in Russian].
  2.  Abdullaev TA. Lechenie perelomov golovki myshhelka plechevoj kosti u detej. Azərbaycan ortopediya və travmatologiya jurnalı. 2017;1:61-8. [in Russian].
  3. Talyshinskij AA, Dzhabiev ZG. Sbornik nauchnyh trudov. NIITO: 1960. s. 145-9. [in Russian].
  4. Magarramov MA. Lechenie slozhnyh perelomov distal’nogo metajepifiza plechevoj kosti u detej [dissertatsia]. M.D: 2009. s. 60-3. [in Russian].
  5. Ahundov AA. Osnovnye principy operativnogo lechenija perelomov dlinnyh trubchatyh kostej u detej. Baku: 1984. 176 s. [in Russian].
  6. Dement’ev EZ, Kirilova ME. Rentgenodiagnostika perelomov kostej loktevogo sustava. Radiologija i praktika. 2019;1:14-24. [in Russian].
  7. Ermak EM. Ul’trazvukovye kriterii ocenki struktury sustavnogo hrjashha i subhondral’noj kosti. Ul’trazvukovaja i funkcional’naja diagnostika. 2015;5:102-14. [in Russian].
  8.  Umarov FH. Lecheniе mnozhestvennyh perelomov verhnej konechnosti u detej. (novye tehnologii v travmatologii i ortopedii: mater. nauchnoprakt. konf. travmatologov-ortopedov respubliki). Uzbekistan-Hiva: 2017. s. 71-2. [in Russian].
  9. Omurbekov TO, Sulajmanov BA. Taktika lechenie nad-chrezmyshhelkoyh perelomov plechevej kosti u detej. 2012. s. 287-90. [in Russian].
  10. Merkulov VN, Dorohin AI, Stuzhina VT, El’cin AG, Mininkov DS. Lechenie perelomov oblasti loktevogo sustava u detej i podrostkov. Vestnik travmatologii i ortopedii. 2011;2:38-45. [in Russian].
  11. Vabovnikov AV. Diagnostika i lechenie perelomov kostej, obrazujushhih loktevoj sustav [dissertatsiya]. M.: 2016. s. 317. [in Russian].
  12. Chapman VM, Grottkau BE, Albright M, Salamipour H, Jaramillo D. Multidetector computed tomography of pediatric lateral condylar fractures. Journal of Computed Assist Tomography. 2015;29(6):842-6.
  13. Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part 2: abnormalities of the ligaments, tendons and nerves. Skeletal radiology. 2015;34(12):1-18.
  14. Pillen S, Van Keimpema M, Nievelstein R. Skeletal muscle ultrasonography: visual versus quantitative evaluation. Ultrasound in Medicine and Biology. 2016;32:1315-21.

Publication of the article:

«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 245-250 pages, index UDK 616.717.4-001.5-089-053.2

DOI: