Supracondylar fractures of the humerus in children and adolescents: current views on diagnosis and treatment
DOI:
https://doi.org/10.32782/2415-8127.2024.69.1Keywords:
humerus, supracondylar fractures, children, adolescents, diagnosis, treatmentAbstract
Fractures of the distal epimetaphysis of the humerus in children and adolescents are one of the most common injuries, accounting for 16 to 50% of bone fractures in general and 50–80% of all intra-articular injuries of the upper extremity. Among the injuries of this location, supracondylar (3–18%) and interspinous fractures (57.5–70%) prevail, mainly in children aged 5 to 9 years. Unsatisfactory treatment results range from 6.67% to 18.2%. The purpose of the study: to determine the modern principles of treatment of supra- and transdiscal fractures in children and adolescents, problematic issues and promising ways to solve them. Material and Methods. The literature was analysed using the Pubmed, Up-to-date, Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health databases using the search terms: supra- and transdigital fractures in children and adolescents, diagnosis and treatment. Results and their discussion. In supracondylar fractures, the most common are neurovascular complications (damage to the brachial artery, median or radial nerves), which are more common in Gartland III fractures. The relative incidence of nerve damage after supracondylar humerus fractures is 12–20%, including 2–6.5% of iatrogenic origin, which occurs during closed reduction and percutaneous fixation. Vascular lesions associated with fractures of the distal metaepiphysis of the humerus occur in 3.2–14.3%. An important debatable issue is the methods of fixation of fragments after closed and open reduction. To date, there are two most common configurations for fixation of supracondylar fractures in children and adolescents: a crossed pinning design (the most common) and a design using 2 or 3 lateral pins with their divergence in the coronal plane. Conclusions. 1. Supracondylar fractures are one of the most common injuries of the distal end of the humerus, more common in boys aged 4 to 9 years (58.3% of cases). A significant proportion of neurovascular complications in these fractures against the background of the peculiarities of children and adolescents in terms of subjective sensations requires a targeted study during the initial examination. 2. Deepening of knowledge through anatomical and biomechanical studies of the characteristics of structures with crossed and coronal use of fixation elements will improve the existing ones and will become the basis for the development of new fixation devices, which will significantly improve the results of treatment of supracondylar fractures in children and adolescents.
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