Biodegradable fixation of distal humeral physeal fractures

Polyglycolic acid (PGA) has been used worldwide as a biodegradable suture material since 1970. Biodegradable polyglycolide implants were introduced in osteofixation of cancellous bone fractures in 1985. From September 1987 to September 1989, 19 consecutive children with physeal fractures of the distal humerus necessitating open reduction and internal fixation were treated by transphyseal biodegradable fixation using 1.5 x 60-mm2 self-reinforced polyglycolide (SR-PGA) pins. Included were nine displaced fractures of the lateral humeral condyle, five severe avulsions of the medial epicondyle of the humerus, four displaced fractures of the humeral capitellum, and one intraarticular fracture of the medial condyle of the humerus. After accurate reduction, two smooth Kirschner pins 1.5 mm in diameter were introduced across the growth plate for temporary fixation. The metallic pins then were removed one by one and subsequently replaced with the cylindrical SR-PGA pins 1.5 mm in diameter. After operation, a padded plaster splint was worn for four weeks. Neither secondary displacement nor signs of growth disturbance were seen during the 26-month follow-up time (mean, 17.2 months). Not only the reduction of the costs but also the psychological aspects should be considered when dealing with biodegradable fixation of physeal fractures in children. Transphyseal biodegradable fixation has established itself as a procedure of choice for handling simple physeal fractures.