Malunions after fractures are classified as shortened, angulated, torsion, or rotational deformities that is outside the acceptable range, regardless of the location, whether upper or lower extremity. The distinct feature of a malunion in the upper extremity is that it is free from weight bearing; thus, some degree of shortening is allowed compared with the contralateral normal side in long bones, such as the humerus, radius, or ulna. However, malunions associated with functional impairment, especially angulated or rotational deformities, are more likely to develop instability, degenerative lesions, or rarely, compressive neuropathy. Hence, malunions with such association may occasionally require correction.
The minimally invasive plate osteosynthesis (MIPO) which is extensively performed, is very dependent on the indirect reduction technique to prevent the exposure of fracture sites. Indirect reduction with the use of the femoral distractor is a much more efficient technique to restore the length in the fracture of lower limbs. However, the femoral distractor cannot be used for fracture of upper limbs, and other instruments for indirect reduction have not yet been reported. Therefore, we introduce the novel indirect reduction technique with the use of the lumbar spreader for the MIPO of upper limbs.
PURPOSE To investigate the etiologic factors related to refractures of the upper extremity in children MATERIALS AND METHODS: 18 refractures of the upper extremity were divided into three groups according to the location of initial fractures: Supracondyle fractures of the humerus, lateral condyle fracture of the humerus, and the forearm bone fractures. They were analyzed in terms of the type of refractures (early refracture occurring at the immature callus and late refracture occurring at the remodeled bone), fracture patterns, and the existence of underlying deformity. RESULTS Nine supracondyle fractures had refractures at the supracondyle (2 cases) and the lateral condyle (7 cases), in which underlying cubitus varus were present in 6 cases. Three lateral condyle fractures had refractures at the supracondyle (1 case) and the lateral condyle (2 cases), in which one case had underlying cubitus varus. All but one case in the group of humerus fractures were late refractures and treated operatively except one. Of 6 refractures of forearm, 5 were early refractures and occurred within 9 weeks at the original site: 4 at the diaphysis of both bones of forearm and 1 at the diaphysis of ulna. All cases in the group of forearm fractures had volar angulation before the refracture, and treated conservatively except one CONCLUSION: In the humerus, underlying cubitus varus was the most important predisposing factor to refractures and the lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis were related to refractures, and complete and circular consolidation of the primary fracture of forearm was thought to be important to prevent refracture.
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