Treatment of a Pediatric T-type Intercondylar Humerus Fracture With Hybrid Percutaneous Pinning and External Fixation

• Published in: Orthopedics (Thorofare, N.J.) Vol. 40; no. 6; pp. e1096 - e1098
• Main Authors: Stroh, D Alex, Sullivan, Brian T, Shannon, Brett A, Sponseller, Paul D
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.11.2017
• Subjects: Bone Nails; Child; Closed Fracture Reduction - instrumentation; Closed Fracture Reduction - methods; Dissection; Elbow; Elbow - physiology; External Fixators; Humans; Humeral Fractures - physiopathology; Humeral Fractures - surgery; Injuries; Male; Pediatrics; Range of Motion, Articular; Skin & tissue grafts; Teenagers; Visualization; Maryland; Baltimore Maryland
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20170602-05

T-type intercondylar fractures of the distal humerus are rare injuries in skeletally immature patients. Few studies are available to guide the treatment of these injuries. Small case series and expert recommendations suggest superiority of the open approach for direct reduction of the articular surface. This approach poses risks of vascular compromise and elbow stiffness. However, success with percutaneous intercondylar screw fixation has been described for simple split patterns. The authors present a case that illustrates a novel percutaneous technique to treat this fracture type. A healthy 8-year-old boy sustained a T-type intercondylar fracture of the distal humerus (AO 13-C1). Excellent reduction was noted after closed reduction and crossed percutaneous pinning. Compression was applied across the pins through a small external fixator bar to address the intercondylar split component. At the 6-week postoperative clinic visit, the pins and fixator were removed uneventfully, and normal healing with full range of elbow motion was noted. This case report describes a simple, minimally invasive technique to treat uncomplicated T-type intercondylar fractures of the distal humerus in skeletally immature patients. Practitioners familiar with percutaneous fixation of supracondylar fractures can easily perform this technique. The described technique spares an open dissection and avoids permanent implants around the joint. Further multicenter research is warranted to determine the long-term outcomes and safety of the described technique. [Orthopedics. 2017; 40(6):e1096-e1098.].