Journal of Musculoskeletal Trauma

Cubitus Varus Resulted from Fracture-Separation of the Distal Humeral Epiphysis: Sung Soo Kim, Sang Hwan Park, Kyoung Sik Hwang; J Korean Soc Fract 2001;14(4):769-775. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.769

Abstract PDF: PURPOSE
We tried to find the cause of cubitus varus after treatment of fracture separation of the distal humeral epiphysis.
MATERIALS AND METHODS
We reviewed 13 cases of fracture-separation of the distal humeral epiphysis. Five cases were treated by open reduction and K-wire fixation, 8 cases were treated by closed reduction and K-wire fixation. Six cases of cubitus varus were evaluated.
RESULTS
With the average 27 months(14-96 months) of follow-up, six of 13 cases showed cubitus varus postoperatively and mean carrying angle was -6.7 degrees(range -3~-15 degrees). None of these cases showed the progression of deformity after then. Among the six cases, five cases were treated with closed reduction, and one case with open reduction. Average age of the cubitus varus cases was 31 months (14-60 months). Among the six cases, four cases were Salter-Hams type I and two cases were type II.
CONCLUSION
Incomplete reduction seems to be the cause of cubitus varus in fracture-separation of the distal humeral epiphysis, so the anatomical reduction is important to prevent the cubitus varus.

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Fracture-Separation of the Distal Humeral Epiphysis in Young Children: Hyoun Oh Cho, Kyoung Duck Kwak, Byung Yong Kim, Su Min Sohn, Pill Whan Oh; J Korean Soc Fract 1999;12(2):365-371. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.365

Abstract PDF: We have reviewed seven cases of fracture-separation of the distal humeral epiphysis, two of which were initially misdiagnosed as a fracture of the lateral condyle and one as a fracture of the supracondyle. The four cases were treated by closed reduction and cast immobilization, and three cases by open reduction and internal fixation. The one case with conservative treatment had cubitus varus, other were good result. To distinguish the fracture-separation from a fracture of lat. condyle and from a dislocated elbow is impossible using clinical signs alone. For reducing misdiagnosis, it is important to consider age and there could be need further evaluation such as arthrogram, USG, CT and MRI.

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Fracture-separation of the Distal Humeral Epiphysis in Children: Yeo Hon Yun, Jong Keon Oh; J Korean Soc Fract 1998;11(4):977-984. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.977

Abstract PDF: We retrospectively reviewed twelve cases of the fracture-separation of the distal humeral epiphysis, which were treated during the period from 1989 to 1996. The incidence of this injury was about 3 % from 266 pediatric elbow fractures. Four cases were remained misdiagnosed as the lateral or medial humeral condylar fracture until the authors reviewed their radiographs. Though eleven fractures were extension type injury with typical posteromedial displacement, we identified a rare flexion type injury with anterolateral displacement. This case was a 12+7 year old boy, who was the oldest in our series. Cubitus varus deformity of more than 10 developed in five patients, and cubitus rectu intwo patients. One patient underwent osteotomy for the in the literature. The major problem of this fracture was the possibility of misdiagnosis. Whichever reament modality onr may choose, careful evaluation of the carrying angle after reduction is mandatory to avoid residual cubitus varus deformity.

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Fracture-Separation of The Distal Humeral Epiphysis: Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Seung Joon Shin, Jeong Tae Kim; J Korean Soc Fract 1998;11(3):650-657. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.650

Abstract PDF: A fracture-separation of the distal humeral epiphysis in children is an extremely rare injury and presents problems in diagnosis, radiographic interpretation and management. From June 1992 to December 1996, Authors experienced the 5 cases of Salter - Harris type II injury of the distal humeral epiphysis at Department of Orthopedic Surgery, Pusan Maryknoll General Hospital. The patient were followed up from one year nine months to three years four months. The two cases were treated by closed reduction and percutaneous K-wire fixation and the three cases by open reduction and internal fixation with K-wires. There were 4 cases of complication seldom reported following fracture-separation of the distal humeral epiphysis. This complications consist of 4 dissolutions of trochlea, which is one, frank avascular necrosis of trochlea. In 3 cases with open reduction developed the cubitus varus & dissolution of trochlea. We speculate that this complications results from avascular necrosis of distal end of humerus. Attention to change of carrying angle and radiographic change of distal humeral end are important in detection of complication & evaluation of etiology of dissolution of distal humeral end.

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Fracture-SeFaration Involving the Entire Distal Humeral Epiphysis in a Young Child(Salter-Harris type I injury): A Case Report: Jong Ho Jang, Seung Gyun Cha, Kyoung Hoon Kim, Jeon Oh Kang; J Korean Soc Fract 1996;9(3):674-677. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.674

Abstract PDF: Fracture-separation of the distal humeral epiphysis is a rare injury, frequently misdiagnosed as a fracture of the lateral humeral condyle, a supracondylar fracture of the humerus or a dislocation of the elbow. Roentgenographic evaluation reveals posteromedial displacement of the distal epiphysis. Single contrast arthrography is performed in order to confirm diagnosis. Treatment is first directed toward prompt recognition of the injury. A manipulative closed reduction is usually recommended. We experienced a case of fracture-separation involving the entire distal humeral physis treated by closed reduction and percutaneous pinning. The result was excellent.

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Triplane Fracture of the Distal Tibial Epiphysis: Jin Hwan An, Jae Keun So, Jae Chul Ok; J Korean Soc Fract 1995;8(4):870-877. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.870

Abstract PDF: The triplane fracture of the distal end of the tibia in adolescents is considered uncommon injuries, but recently it has received considerable attention in the orthopaedic literature. We reviewed five patients who had been treated at Kyung Hee University Hsopital for triplane fractures and followed up at least one year. The purposes of this paper were to determine the configuration of the fracture and the results of treatment. The cause of injury was slip down in three patients, fall down in one patients and sports injury in one patient. The mechanism of injury was supination-external rotation in four patients and unknown in one patient. The plain x-ray and CT were evaluated in all patients. On radiological evaluation, the initial displacement more than 2mm observed in four patients, but displaced fractures were reduced less than 2mm after treatment. The two fragment fractures were seen in two patients, three fragments in three patients. At last follow-up, complete union with anatomical position occurred without degenerative change of ankle joint and any deformity. We treated operatively in two patients, one with arthroscopic reduction and percutaneous pinning, the other with open reduction and internal fixation. Also we treated conservatively in one minimal displaced fracture and two displaced fractures. The results were graded using a modification of the Weber protocol. Points were assigned for pain, walking, activity, radiographic findings, function of the ankle joint, and deformity. The results was classified as excellent in 5 patients and good, fair and poor results was none. The complications was not developed in atl patients. The initial displacement, No. of fragments and treatment method were not significantly affect the results of treatment. Finally, we had excellent results in triplane fracture if the reduction less than 2mm regardless initial displacement can obtained.

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Bilateral Subtrochanteric fracture After Pin Removal in Slipped Capital Femoral Epiphysis: A Case Report: Sung Joon Kim, Il Young Choi, Tai Seung Kim, Chung Kyu Choi; J Korean Soc Fract 1995;8(1):68-71. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.68

Abstract PDF: Subtrochanteric fracture of the femur has been infrequently reported after pin removal that is second operation for slipped capital femoral epiphysis and that fracture is a serious complication. We report a case of subtrochanteric fracture of the femur occured after pin removal that had been inserted for fixation of slipped capital femoral epiphysis. Its treatment was open reduction with condylar blade plate and screws. We recommend insertion of fewer pins and longer pins at higher level, early pin removal, avoidance of repeated insertion and use of cannulated pin screw instead of Knowles pin for prevention of subtrochanteric fracture after pin removal.

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Fracture-separation of the Distal Humeral Epiphysis: A Case Report: Kwon lck Ha, Sung Ho Hahn, Bo Kyu Yang, Chi Hong Kim, Tae Sung Kim; J Korean Soc Fract 1995;8(1):101-105. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.101

Abstract PDF: The fracture-separation of the distal humeral epiphysis is considered to be a rare injury. It presents problems in diagnosis, radiologic interpretation and management. It is frequently misdiagnosed as a dislocation of the elbow or a fracture of the lateral humeral condyle because the cartilagenous distal portion of the humerus in the children is not visible on roentgenograms. A knowledge of when the ossification centers appear about the elbow is absolutely necessary in the diagnosis of the elbow injury. We experienced 1 case, a 22 month-old girl with Salter-Harris type I[ injury of the distal humeral epiphysis.

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