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Incidence, treatment techniques, and results of distal humeral coronal shear fractures in children and adolescents—a multicenter study of the German Section of Pediatric Traumatology (SKT)

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Distal humeral coronal shear fractures (CSF) are uncommon and may be challenging to treat due to their size, location, and intraarticular nature. The purpose of this study was to analyze treatment concepts of this rare entity in the growing age.

Methods

Based on a multi-center data analysis we retrospectively reviewed patients below 16 years of age with CSF treated at 13 high-volume pediatric trauma centers.

Results

Data from 51 patients with a CSF treated between 01/2012 and 12/2021 were analyzed. The mean age was 12.9 years (10–15), and there was a trend towards male patients (30: 21). The initial diagnostic approach was conventional X-ray in all cases. In addition, a CT scan (n = 33), MRI scan (n = 9), or both (n = 3) were performed. All fractures except two showed relevant displacement. Consequently, only two cases received conservative treatment consisting of plaster immobilization. Surgical treatment was performed in 49 cases consisting of open or mini-open reduction and metal/resorbable screw osteosynthesis (n = 39), plates (n = 4), K-wire pinning (n = 6), and others (n = 6), as well as combinations. In 1 case open reduction without osteosynthesis was performed. Postoperative additional plaster immobilization was performed in 40 cases (for a mean of 19 days (2–42)), physiotherapy was initiated in 29 cases, and metal removal was performed in 28 cases (after a mean of 18.1 weeks (4–44)). After a mean follow-up of 9.9 months (2–25), elbow axial deviation (5° valgus) was observed in one case and mild loss of elbow ROM in six cases (11.7%). Complications included revision of the osteosynthesis because of insufficient articular reconstruction (n = 4), removal of a free joint body (n = 1), an osteonecrosis (n = 1), and a cartilage defect (n = 1).

Conclusion

In pediatric patients CSFs start to occur at the age of 10, but are typically observed at the age of 13 and older. Because of their intraarticular nature and predilection toward displacement, these fractures are frequently treated operatively. The surgical strategy requires open reduction and anatomic reconstruction of the articular surface. Stable internal fixation, most often achieved by screws, permits early mobilization and leads to good outcomes in most cases. This is presumably due to the fact that mostly simple fractures occur in children and mostly complex injuries in older adults.

Level of evidence: III, retrospective analysis.

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Availability of data and material

The datasets analysed during the current work are available from the corresponding author upon reasonable request.

Code availability

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Acknowledgements

The authors would like to acknowledge the following members of the SKT (Section of Pediatric Traumatology of the German Association of Traumatologists) participating in this study for contributing cases and data (in alphabetical order): F. Bergmann, München; F. Fernandez, Stuttgart; P. Schmittenbecher, Karlsruhe; D. Schneidmüller, Murnau; P. Strohm, Bamberg.

Funding

This study was not supported by any grants, funds, or others.

Author information

Authors and Affiliations

  1. Clinic for Trauma Surgery and Orthopedics, Klinikum Bad Hersfeld, Bad Hersfeld, Germany

    Ralf Kraus

  2. Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tübingen, Tübingen, Germany

    Justus Lieber

  3. Department of Pediatric Surgery, University Hospital Dresden, Technical University of Dresden, Dresden, Germany

    Philipp Schwerk

  4. Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany

    Hauke Rüther

  5. Department of Pediatric Surgery, University Hospital Schleswig Holstein-Campus Lübeck, Lübeck, Germany

    Ludger Tüshaus

  6. Department of Orthopedics and Trauma Surgery, University Hospital Freiburg, Freiburg, Germany

    Nikos Karvouniaris

  7. Department of Pediatric Traumatology, Altona Children’s Hospital, Hamburg, Germany

    Dirk W. Sommerfeldt

  8. Department of Pediatric Traumatology and Surgery, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

    Martin M. Kaiser

  9. Department of Pediatric Traumatology, Bergmannstrost Hospital Halle, Halle (Saale), Germany

    Martin M. Kaiser

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Consortia

the Section of Pediatric Traumatology (SKT) of the German Association of Traumatology (DGU)

Contributions

All authors contributed to the study’s conception and design. Data collection was performed by members of the SKT (Section of Pediatric Traumatology of the German Association of Traumatologists). Material preparation and analysis were performed by RK and JL. The first draft of the manuscript was written by RK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ralf Kraus.

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Ethics approval

This study was approved by the ethical committee of the University of Halle (Saale) (project no. 2022-103).

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Kraus, R., Lieber, J., Schwerk, P. et al. Incidence, treatment techniques, and results of distal humeral coronal shear fractures in children and adolescents—a multicenter study of the German Section of Pediatric Traumatology (SKT). Eur J Trauma Emerg Surg (2023). https://doi.org/10.1007/s00068-023-02370-1

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