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Comparison of treatment results for fractures of the distal humerus in children according to the indication for conservative or surgical solution.

Buturovic S, Krupic F - Mater Sociomed (2014)

Bottom Line: Using chi square and t-test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre).The success of treatment in such institutions corresponds to the results achieved in the world (93.0%).

View Article: PubMed Central - PubMed

Affiliation: General Hospital Konjic, Konjic, Bosnia and Herzegovina.

ABSTRACT

Introduction: Records about the fractures of the distal humerus could be founds in the scriptures written long before Christ (Hippocrates 300 to 400 BC). During the twilight of science development and of any scientific work (the Middle Ages), little has been written about this problem. Between the 1700 and 1800 much was discussed about the controversies between the correct position and immobilization. In the early twentieth century view on the treatment of fractures of the distal humerus begins to change dramatically, from the former passive to active surgical treatment. The sudden turnaround followed thanks to the intensive development of technology, especially new imaging technology.

Material and methods: We observed a period of 4 (four) years (1998 to 2002), and only hospital patients of certain age. As database are used the histories of the disease. The patients were followed for one year and at the same time, we analyzed (clinical) early complications after three (3) months and late complications (X ray), after a year. Among the early complications we observed most often lower motility and contraction, and of late we have followed the morphological deformation-cubitus varus and valgus.

Results: Using x-ray images, we measured Baumann's (en face) and lateral condylar angle (profile) after one year in the operated group and the group treated conservatively SPDH type III in children. We calculated the arithmetic mean (x) and a standard deviation (SD) in both groups. Using chi square and t-test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.

Conclusion: All humerus fracture type-III by Gartland in children should be surgically treated. Surgery should be undertaken in a time frame of 6 hours. Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre). The success of treatment in such institutions corresponds to the results achieved in the world (93.0%). We must be sure to adopt and implement a scheme of treatment of fractures of the distal humerus in children. Required is faint trail, OPF, lateral (Kaplan) approach, exceptionally for some articular fractures posterior approach by Campbell, fixation with two or more Kirchner's needles, usually cross-set at an angle of 30°, vacuum drainage with cast immobilization.

No MeSH data available.


Related in: MedlinePlus

Example from the war period - General Hospital Konjic (contractures, bone transformation of the joint cavity)
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Figure 2: Example from the war period - General Hospital Konjic (contractures, bone transformation of the joint cavity)

Mentions: In SPDH in childhood type I and II, in our study, 38.2% is treated conservatively, at the level of general hospitals (Hospital Konjic) without complications. These cases can be resolved on outpatient basis, if possible with permanent control of the neuro-vascular status, otherwise it is required shorter hospitalization (several days). SPDH in childhood of type III and IV must be treated in specialized institutions at the clinical level, to avoid the problem of the development of chronic complications, which lead to functional and morphological deformities permanent character (Figure 2).


Comparison of treatment results for fractures of the distal humerus in children according to the indication for conservative or surgical solution.

Buturovic S, Krupic F - Mater Sociomed (2014)

Example from the war period - General Hospital Konjic (contractures, bone transformation of the joint cavity)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214806&req=5

Figure 2: Example from the war period - General Hospital Konjic (contractures, bone transformation of the joint cavity)
Mentions: In SPDH in childhood type I and II, in our study, 38.2% is treated conservatively, at the level of general hospitals (Hospital Konjic) without complications. These cases can be resolved on outpatient basis, if possible with permanent control of the neuro-vascular status, otherwise it is required shorter hospitalization (several days). SPDH in childhood of type III and IV must be treated in specialized institutions at the clinical level, to avoid the problem of the development of chronic complications, which lead to functional and morphological deformities permanent character (Figure 2).

Bottom Line: Using chi square and t-test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre).The success of treatment in such institutions corresponds to the results achieved in the world (93.0%).

View Article: PubMed Central - PubMed

Affiliation: General Hospital Konjic, Konjic, Bosnia and Herzegovina.

ABSTRACT

Introduction: Records about the fractures of the distal humerus could be founds in the scriptures written long before Christ (Hippocrates 300 to 400 BC). During the twilight of science development and of any scientific work (the Middle Ages), little has been written about this problem. Between the 1700 and 1800 much was discussed about the controversies between the correct position and immobilization. In the early twentieth century view on the treatment of fractures of the distal humerus begins to change dramatically, from the former passive to active surgical treatment. The sudden turnaround followed thanks to the intensive development of technology, especially new imaging technology.

Material and methods: We observed a period of 4 (four) years (1998 to 2002), and only hospital patients of certain age. As database are used the histories of the disease. The patients were followed for one year and at the same time, we analyzed (clinical) early complications after three (3) months and late complications (X ray), after a year. Among the early complications we observed most often lower motility and contraction, and of late we have followed the morphological deformation-cubitus varus and valgus.

Results: Using x-ray images, we measured Baumann's (en face) and lateral condylar angle (profile) after one year in the operated group and the group treated conservatively SPDH type III in children. We calculated the arithmetic mean (x) and a standard deviation (SD) in both groups. Using chi square and t-test, with the probability of 95%, we showed that there is a significant difference between operative and conservative treatment of SPDH type-III in children, according to Gartland.

Conclusion: All humerus fracture type-III by Gartland in children should be surgically treated. Surgery should be undertaken in a time frame of 6 hours. Surgery should be done in these cases by the specialized institutions (Clinical Hospital Centre). The success of treatment in such institutions corresponds to the results achieved in the world (93.0%). We must be sure to adopt and implement a scheme of treatment of fractures of the distal humerus in children. Required is faint trail, OPF, lateral (Kaplan) approach, exceptionally for some articular fractures posterior approach by Campbell, fixation with two or more Kirchner's needles, usually cross-set at an angle of 30°, vacuum drainage with cast immobilization.

No MeSH data available.


Related in: MedlinePlus