The transcondylar fractures in children, particularities of diagnosis and treatment

Abstract

Introduction. Transcondylar fractures of the humerus are the most frequent fractures at the level of elbow facing children. These can be extremely difficult to manage and if the way if treatment is not correct, then complications such as joint stiffness could appear. Aim of study. Appreciation of diagnostic features and treatment of transcondylar fractures in children. Methods and materials. This study included 115 patients with ages varying between 3 years to 18 years old, 75 boys and 40 girls, who presented themselves to IMSP Mother and Child Institute from Chisinau, department of Orthopedics, Traumatology and Vertebrology between 2021 and 2022. All these children were subject to transcondylar fractures of the humerus. Results. Patients have been categorized by gender: 40 girls (35%) and 75 boys (65%). In 63 of the children (55%) the upper side of the right member has been affected, while in 52 children (45%) has been affected the upper side of the left member. Considering the symptomatic point of view, the most common sign of all has been the significant pain (100%) to the affected member. Other clinical characteristics have been such as oedema (100%) and hematoma (85%). The diagnosis was given based on the clinical examination and radiological assessment of the affected member in two incidents (front and lateral). The I-III grade fractures (Lagrange-Rigault Classification) have had indication for orthopedic treatment (37%), while the IV-V grade fractures have had indication for surgery (63%). After the surgical interventions, they have undergone treatment with antibiotics, inflammatory, local treatment with aseptic dressings. The threads have been removed on day ten. The duration of 80% from the surgeries has been around 30-40 minutes. The plaster cast immobilization was kept 3 weeks, after which it was removed together with brooches. The recovery treatment after the removal of immobilization contained physical therapy and light massage. Conclusion. Transcondylar fractures are predominant for masculine gender and mainly affected is the right upper member. Orthopedic treatment is recommended for I-III grades (Lagrange Rigault Classification), while the surgery is compulsory in IV-V grades or in case of failure in orthopedic treatment. The cases with late diagnosis (over 3-5 days after the trauma) need surgical intervention to reconstruct the elbow joint.