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[Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants]
1Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China.
Insights
Elbow arthrography via lateral approach accurately diagnoses infant elbow fractures, improving treatment selection and outcomes. This minimally invasive technique minimizes misdiagnosis and missed injuries, leading to excellent functional recovery.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Skeletal Trauma
Background:
- Infantile elbow fractures require precise diagnosis for effective treatment.
- Traditional imaging may miss subtle cartilage damage in pediatric elbow injuries.
Purpose of the Study:
- To assess the efficacy of elbow arthrography using a lateral approach for diagnosing and guiding treatment of elbow fractures in infants.
Main Methods:
- Retrospective analysis of 24 infants with elbow fractures treated between May 2016 and May 2018.
- All patients underwent elbow arthrography via a lateral approach.
- Fracture types included humeral lateral condylar, distal humeral epiphysis, Monteggia, and radial neck fractures.
- Treatment varied based on fracture type, including Kirschner wire fixation and plaster casting.
Main Results:
- Elbow arthrography via lateral approach showed no adverse reactions.
- Follow-up (14-38 months) revealed excellent fracture healing without malunion or premature physeal closure.
- Significant improvements in carrying angle and elbow range of motion were observed post-treatment (P<0.001).
- 95.8% of patients achieved excellent or good outcomes based on the Flynn criteria.
Conclusions:
- Lateral approach elbow arthrography is effective in diagnosing cartilage damage in infant elbow joints.
- This technique reduces misdiagnosis and missed injuries, aiding in treatment selection.
- The procedure contributes to successful management and functional recovery of pediatric elbow fractures.
Objective:
To evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.
Methods:
The clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used.
Results:
None of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation ( t=22.670， P=0.000； t=11.910， P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%.
Conclusion:
Elbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.
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