Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures
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Original Contribution Obere Extremität https://doi.org/10.1007/s11678-020-00606-9 Received: 6 June 2020 Accepted: 17 September 2020 © The Author(s) 2020
N. Ott · M. Hackl · T. Leschinger · K. Wegmann · L. P. Müller Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures A systematic review
Supracondylar fractures of the humerus are the most common type of elbow fractures in childhood [5, 9]. The peak age at which supracondylar fractures occur is between 5 and 7 years [16]. The majority of these injuries are extension-type fractures accounting for up to 98% of cases. They occur mostly by falling on an outstretched hand with the elbow in full extension especially on the left or non-dominant side [5, 16]. Gartland described a rotatory and translational deformity, with posterior displacement (extension) of the distal fragment occurring most often [5]. He described three types of extension injury based on the degree of displacement—type I, nondisplaced; type II, moderately displaced; and type III, severely displaced injury—and he considered flexion-type injuries separately [5]. Due to the potential risk of severe complications of these fractures, trauma surgeons should address these injuries with caution. Neurovascular injuries are frequent and there may be severe acute complications, which have been reported to occur in up to 12% of displaced fractures [8]. Late complications include secondary deformities due to malunion, usually cubitus varus [13]. However, rarely, other late complications are cubitus valgus, premature epiphyseal arrest, or fishtail deformity [20]. According to the recent data, avascular necrosis of the trochlea after a supracondylar humerus fracture is uncommon and a limited number of cases have been reported in the literature [2, 3, 7, 14, 15, 17]. Hence, the aim of
this study was to systematically review the literature in order to evaluate possible predictors for this kind of uncommon late complication of supracondylar distal humerus fractures in childhood.
Methods In this study, we systematically reviewed randomized clinical trials, observational studies, and case series. We included studies without language restriction. A minimum follow-up of 6 months should be available. We excluded studies evaluating fishtail deformity or trochlea necrosis in other primary injuries (fracture of the medial or lateral condyles). We searched PubMed and Cochrane Library (February 22, 2020) using the search terms: OR OR AND OR OR AND AND OR OR One author (N.O.) conducted the literature research and scanned all references for eligibility. Articles that could not clearly be excluded were retrieved in fulltext and read independently by two authors (N.O. and K.W.), who decided independently on eligibility. Disagreements were resolved by discussion. Two authors (N.O. and K.W.) using pre-tested forms extracted studycharacteristics and results independently. In cases of discrepancies between d
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