Long-term outcomes of distal humeral epiphyseal separations treated via closed reduction and pinning under arthrogram

Abstract

Background: The purpose of this study is to report the longterm radiological and clinical outcomes of the distal humeral epiphyseal separations (DHESs) treated by arthrogram-assisted closed pinning, retrospectively.

Methods: Among patients surgically treated from February 2000 to March 2010, 12 patients followed-up for at least 7 years were investigated. After careful inspection of initial simple radiographs, we performed intraoperative arthrogram for all children, confirmed DHES status, and concluded with closed reduction and pinning. At the final follow-up, the radiological and clinical outcomes were evaluated.

Results: The mean age at injury was 23.5 months, and four patients were male (42%). The mean age at final follow-up of 12 children/adolescents was 11.6 years. The mean follow-up period was 9.7 years (116.2 months). The dominant arm was injured in seven children. Two, seven, and three children were of the modified DeLee classifications A, B, and C, respectively. At the final follow-up, the mean humeral lengths of the injured and contralateral (normal) sides were 24.00 cm and 24.1 cm, thus not significantly different (P = 0.32). The final carrying angles were 10.75°, with significantly different with contralateral side (13.67°, P = 0.011). However, final shaft-condylar angles were not different (P = 0.207). There was no finding of avascular necrosis around trochlear area in all patients. The mean MEPS was satisfactory and the flexion/extension ranges were similar to those of the normal side (P = 0.317, 0.083).

Conclusions: K-wire fixation via the arthrogram is useful when treating DHES, as it enhances anatomical reduction and minimizes later risk of cubitus varus. The clinical outcomes in school-age children and adolescents were satisfactory in most cases; however, longer follow-up of adolescents with cubitus varus is required.

Level of evidence: Level IV, Therapeutic.

Keywords: Arthrogram; Cubitus varus; Distal humerus; Epiphyseal separation; Mayo elbow performance score.