Osteosynthesis in intraarticular fractures in children

Abstract

Objective of study. Intraarticular fractures in children are the most complicated fractures, but failures in diagnosis, treatment tactics and technique of these fractures lead to unsatisfactory results, occurrence of post-traumatic deformities, disorders of function and growth. Material and methods. Over 50 years we have operated approximately 2,000 children with intraarticular fractures, aged between 10 months and 18 years. Over 95% of those operated had complicated elbow fractures and follow-up consequences. The surgical method included: an appropriate approach for perfect adaptation of fragments without muscle and tendon sections, without osteotomies; restoration of traumatized muscles; perfect reposition of fragments; relatively stable and fine osteosynthesis with 3 Kirschner pins, and external plaster cast immobilization. After immobilization and removal of pins, the rehabilitation treatment was performed through physical therapy with independent forceless and painless movements. Results. Treatment outcomes depend on the duration after trauma, the quality of anatomical adaptation of fragments, protection of periarticular tissues, fine fixation of fragments with pins, prevention of hematomas and bone consolidations. The compliance with all the requirements of surgical treatment allowed to obtain good results in over 96% of operated children. Discussions. Intraarticular fractures in children, regardless of their age and degree of fracture displacement, require surgical treatment in specialized clinics, conducted by highly qualified specialists. Pseudoarthrosis in intraarticular fractures develops after orthopedic treatment or poorly performed surgical treatment. Fine osteosynthesis with Kirschner pins ensures the necessary stability. Osteosynthesis with plates and bolts is inadmissible, while olecranon osteotomy is a major error. Any postoperative varus deformity should be considered as an unsatisfactory result. This deformation may trigger secondary distal humeral epiphysiolysis with irreversible disability. For this reason, we disagree with the views of some authors who consider varus deformity in children up to 20 degrees a good result and varus deformity up to 40 degrees is considered a satisfactory result, which, in fact is erroneous for child development. Conclusion. In intraarticular fractures in children it is necessary to appreciate in detail the intricate anatomical and topographical changes. The surgical treatment of complicated fractures has to be performed in specialized clinics by highly qualified doctors in the field.