Elbow fracture sequelae in children

BACKGROUND: Fractures of elbow joint bones are the most common type of fracture in children. Despite methodological advances in managing these injuries, adverse anatomic and functional outcomes are still common in clinical practice. AIM: The aim was to evaluate the structure of primary injuries and primary treatment strategies to evaluate the sequelae of elbow bone fractures in children. MATERIALS AND METHODS: Based on inclusion criteria, a retrospective cohort (n = 115) was formed. Clinical, historical and radiological data were evaluated in patients with sequelae of elbow fracture, admitted for surgical treatment in the clinic of the H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery of Russia in 2022–2023. The Shapiro–Wilk test (for less than 50 subjects) or the Kolmogorov–Smirnov test (for more than 50 subjects) were used to test the normality of quantitative parameters. The Pearson’s chi-squared test was used to compare percentages in the contingency table analysis. RESULTS: The mean age of patients in the study population was 11 years (ranging from 4 to 17 years). The duration of injury is 15.6 ± 1.0 months (min = 3; max = 65). Based on the structure of the sequelae, three groups were identified: patients with contracture (42 cases; 36.5%), patients with deformity (31 cases; 27%), and patients with both contracture and deformity (42 cases; 36.5%). Supracondylar fractures of the humerus (40%) and apophyseal fracture of the medial epicondyle (31%) were the most common primary injuries. Primary conservative treatment of the fracture was performed in 82 (71%) patients, primary surgery was performed in 33 (29%) children, and 17 patients were switched from conservative to surgical treatment. A total of 31 (27%) children had repeated procedures. CONCLUSIONS: Contractures are the most common adverse outcome of elbow fractures in children. Characteristics of conservative treatment and repeated procedures indicate a need for better training of pediatric trauma surgeons. Even today, despite the development of advanced algorithms, the main causes of adverse outcomes are still errors in diagnosis, care strategies, and intervention techniques.