[Evaluation of AO kit screw fixation of medial condyle and epicondyle distal humeral epiphyseal fractures in children].

In the Pediatric Surgery Department of the Voivodeship Hospital in Koszalin the use of screw fixation claims to be the method od choice for treating the fractures of medial epicondyle and condyles of the distal humeral bone epiphysis in children, thus challenging Kirschner's wire fixation being commonly applied in these traumas, and in consequence making it necessary to compare the results obtained after resorting to each of these methods. The accomplished comparative study covered the total of 101 persons, aged from 5 to 28 years, over the period from 1 to 15 years (mean 6 years) after trauma, treated due to the above-mentioned injuries in the years 1976-1990, at this Department (86 persons), and in the years 1980-1990 at the Pediatric Surgery Clinic of the Pomeranian Medical Academy in Szczecin (15 persons) exclusively by means of Kirschner's wire fixation. In 64 patients screw fixation was implanted, and in 37-Kirschner's wire. The studied material was divided into 4 subgroups (Tab. 1) comprising respectively: 41 persons (subgroup A) after past fracture of medial epicondyle treated by screw fixation; 26 persons (subgroup A1) with past medial epicondyle fracture treated by Kirschner's wire fixation: 23 persons with past condyle fracture treated by screw fixation (subgroup B) and 11 persons after condyle fracture treated by Kirschner's wire fixation (subgroup B1). Three control groups were set up: control group I, showed normal reference values, represented the assessments of healthy ulnar joints contrasting with the previously inflicted injury in 101 persons of the studied group. The control group II, concerning the physical examinations, incorporated 43 persons burdened neither by past trauma, nor by any other lesions of the ulnar joints, randomly selected: 23 children, 12 under the care of their parents, and 11 persons of juvenile age, registered with the pediatric surgery or rehabilitation consulting centres in Koszalin. Control group III, concerned with correct radiologic measurements included 45 persons randomly selected, aged from 5 to 27 years in whom radiograms of their ulnar joints were made on indications not involving the trauma of the joint. The clinical evaluation took into account the anamnesis data, assessment of the ulnar joint shape, appearance of the postoperative scar, innervation status within the ulnar nerve range, measurements of the length of arm, its circumference, flexion and extension movement (with analysis of the range of movement) value of the angle of the arm axis deviation in relation to forearm axis, as well as muscle power. The radiographic evaluation encompassed the measurements of angles: humeral, ulnar, physiological valgity as well as diaphysio-epiphysial one, and moreover, the evaluation of the symphysis quality, outlines of distal epiphysis of the humeral bone and its bony structure. The mentioned parameters of the clinical evaluation, two of the parameters of the radiological evaluation, and also the final point estimation of the treatment results were subjected to statistical analysis by applying the analysis of variance, with the level of significance being accepted as p = 0.05. The noted results have shown that significant findings in the clinical evaluation were primarily the measurements of both the range of movements and the angle of the arm axis deviation, in relation to the forearm axis, while in the radiological evaluation-the symphysis quality estimation and occasionally occurring absence of correlation between the result of clinical evaluation and the radiological one (Fig. 1). Moreover, the recorded results pointed to the screw fixation as being more favourable, than Kirschner's wire fixation, method of treating the mentioned injuries in children (clinical and radiological data were favouring the screw fixation in fractures of medial epicondyle-whereas in condyle fractures-first of all the clinical data). (ABSTRACT TRUNCATED)