Srpski Arhiv za Celokupno Lekarstvo (Jan 2009)
Importance of initial fracture crack width in minimally dislocated fractures of humeral lateral condyle in children for evaluation of fracture stability and treatment choice
Abstract
Introduction. The fracture of the external condyle is the most common fracture of the distal end of the humerus. This is an intraarticular fracture, which, if not properly treated, can cause serious complications, difficult to treat. Objective. To define the importance of the initial width of the fracture crack for the evaluation of stability of the minimally dislocated fractures of the humeral lateral condyle and for the selection of the method of treatment. Methods. The target group included the children with minimally dislocated fractures or fractures of uncertain stability. The number of children was 35. On the grounds of the initial width of the fracture crack, two groups were formed. Group A comprised 25 (71.4%) examinees with the initial width 2-2.9 mm. Group B comprised 10 (28.6%) examinees with the initial width 3-3.9 mm. Measuring was performed on the PA and profile radiographies. A higher value was taken for analysis. The control of fracture crack width was done by systematic radiographies in the following time intervals: the first, third, seventh and the fourteenth day in group A, and the first and third day (1B and 3B) in group B, since the fracture occurrence. Results. The analysis of the results in group A showed the following: the enlargement of dislocation between 1-3 days was significant (p<0.05). Between 3-7 and 7-14 days, there was no significant enlargement of dislocation (p>0.05). Fractures were stable and treated nonsurgically. In group B, the enlargement of dislocation was significant until the third day (p<0.05). These fractures were unstable, there was a great risk for secondary dislocations and they were to be duly fixed. Initial widths of these groups varied significantly (p<0.05). Conclusion. The initial width of the fracture crack is important for the evaluation of the fracture stability, the evaluation of the risk for the creation of secondary dislocations and for the choice of treatment. The upper limit of the fracture crack width which influenced the selection of the method of treatment was 2.5 mm.
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