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Screw fixation for pediatric elbow FXs

Screw fixation for pediatric elbow FXs. Ahmed M. Thabet MD Stephen Heinrich MD. Incidence . 65-75 % of pediatric FXs involves Upper extremity (UE) 7-9% of UE FXs involve the elbow Supracondylar humerus FX (SCH) represents 55-65%

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Screw fixation for pediatric elbow FXs

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  1. Screw fixation for pediatric elbow FXs Ahmed M. Thabet MD Stephen Heinrich MD

  2. Incidence • 65-75 % of pediatric FXs involves Upper extremity (UE) • 7-9% of UE FXs involve the elbow • Supracondylar humerus FX (SCH) represents 55-65% - Lateral condyle (LC) 2nd common pediatric elbow fracture

  3. Poor outcome with pediatric elbow fractures may lead to Litigation 32 malpractice claims filed/242 20 cases confirmed (63%)

  4. Research question? • Study Hypothesis: • Screw fixation provides better stability for unstable pediatric elbow fractures • Aim of the study: • To report the clinical and radiographic outcomes of screw fixation for pediatric elbow Fxs

  5. Patients and methods • IRB approval • Design: retrospective • Chart & radiographs reviews • Study period: 2007-2013 • Inclusion DX: SCH Fxs & LCFXs • Patients RX operatively through CRIF or ORIF with screws only or combined with smooth pins and /or screws • RX by senior author

  6. Outcome score - Flynn criteria

  7. Radiographic review • Fracture type and classification • Fixation method • Union • Complications

  8. ResultsDemographics • Two groups: • LC: 11 • SCH: 17 • Gender: • SCH: • M/F: 8/9 • LC: • M/F: 8/3

  9. Results Demographics • Mean age @SX: • SCH: • 8.6 (5-14) y/o • LC: • 4.8 (1.6- 7) y/o • Side of injury: • SCH • R/L: 6/11 • LC: • R/L: 3/8

  10. ResultsSCH- FX pattern • Types: • Extension type: 14 • Flexion type: 2 • Transcondylar FX: 1 • Gartland classification: • Type II: 4 • Type III: 12 • Transcondylar fracture : 1

  11. ResultsLC FX pattern • Milch’s classification: • Type I:1 • Type II:10 • Jakob’s classification: • Type I:1 • Type II:8 • Type III:2 Type I Type II Type II Type I Type III

  12. Results Associated injuries • Vascular injury: • 2 needed vascular repair • Distal radius FX: 3 • CRIF:1 • Cast: 2

  13. ResultsRX type • SCH group: • CRIF:12 • ORIF: 5 • LC: • CRIF:7 • ORIF:4

  14. ResultsUnion • Union achieved in all cases • Cast removal after fracture healing @ three weeks in SCH Fxs group • ~ 4 weeks in LC group

  15. ResultsComplications • No intra op complications • Post op complication SCH FXs group: • Loss of reduction (1/17):

  16. Type III SCH Fx, 5y/o Boy

  17. Post OP radiographs

  18. Loss of reduction

  19. Revised with crossing pins

  20. @ final FU (3+6 y/o)

  21. Results Flynn criteria • SCH: • 4/17 with poor outcome 2ry to loss of motion>20º • 2 lost extension • 2 lost flexion • LC: • 2/11 poor outcome according to Flynn criteria: • Varus carrying angle --- 1 • Loss of ROM 1----(>20º)

  22. ResultsHWR • Smooth pins @ clinic • Screw removal needs 2nd trip to OR

  23. Cases example

  24. Case 1- LC, 6 y/o M, type II,II

  25. RX with screw fixation Final F/U @ 10 Months

  26. Case 2-5 y/o M, type III SCH Fxs with vascular injury

  27. Intra op radiographs

  28. F/U radiographs

  29. Final F/U @ 6 months

  30. Conclusion • Screw fixation for SC and LC FXs is an alternative option: • Markedly unstable Fx • Multiple injuries in the same extremity • LC Fxs • Associated vascular injury • Further studies are planned to include control matched group Rx with pinning

  31. Thank you

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