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7TECHNIQUES FOR MODIFYING THE TECHNIQUE OF OSTEOSYNTHESIS OF THE HEAD OF THE CONDYLE OF THE HUMERUS IN CHILDREN
Sherzod Nuralievich Eranov
Samarkand State Medical Institute
Otabek Ikromovich Salohiy
Samarkand branch of the Republican
Specialized Scientific-Practical Medical Center of Traumatology and Orthopedics
Utkir Zhamilovich Mamatov
Samarkand branch of the Republican
Specialized Scientific-Practical Medical Center of Traumatology and Orthopedics
Khurshid Kodirjonovich Yusupov
Samarkand State Medical Institute
ABSTRACT
The article describes the results of treatment of 120 patients with fractures of the humeral capitulum. The modification technique of the osteosynthesis technique of the humeral capitulum head is described. Timely diagnostics and skilful application of operative methods of treatment of fractures of the head of the humeral condyle prevents complications: incorrect fusion, incoherence, pseudarthrosis. The fixation of incorrectly healed fracture fragments with our modification allows for stability and prevents secondary displacement.
Keywords: humeral condyle head, osteosynthesis
INTRODUCTION
Fractures of the distal humerusmetaepiphysis in children account for 70-90% of all fractures of the bones making up the elbow joint [1,3] and 25-30% in the overall structure of all limb fractures in childhood. Severe intra-articular fractures of the distal humerusmetaepiphysis are fractures of the humeral condyle head (hereafter HMCA) and, according to several authors [2], represent 3.5 to 20% of all fractures in the elbow joint in children.
The current controversy over the treatment of "fresh" fractures of the HMPC and their consequences and the causes of such frequent complications of these types of injuries indicate the complexity of the problem. Currently, the researchers involved in this problem have no unified viewpoint on the methods of surgical treatment, no unified treatment tactics depending on the type of the fracture of the genitourinary tract. In the case of a single fracture, scientists propose different methods of treatment [3,4]. Unfortunately, this diversity of opinion exists for almost every type of fracture, which inevitably leads to difficulties in selecting a treatment method. This results in the
selection of a suboptimal method of treatment, which leads to a complicated course of the fracture in the form of secondary displacement of the fragment, fracture nonhealing, aseptic necrosis, false joint, and valgus deformity of the elbow joint with late ulnar neuritis [1,8].
The incidence of complications of Humeral Musculoskeletal Fractures in children, according to different authors, ranges from 3.3 % to 54.8 % [4,5]. The results of treating unhealed Humeral Musculoskeletal Fractures are of particular concern. According to a number of authors [5,7], the rate of unsatisfactory results after surgical treatment of healed Humeral Musculoskeletal Fractures ranges from 26.6% to 50%, whereas the outcomes of surgical treatment of pseudarthrosis were good and satisfactory. One of the significant problems in the diagnosis and treatment of HMMC fractures with a complicated course is the insufficient study of the causes of consolidation failure and the lack of a comprehensive examination. Currently, in the examination of children with fractures and their sequelae, the main diagnostic method is roentgenology; less frequently, the most promising diagnostic methods such as computed tomography, thermography, laser Doppler flowmetry, and ultrasonography are used [3,6].
In the case of a timely multidisciplinary examination, the consolidation disorders of a BMC fracture can be detected at an early stage. This requires revision of the principles of treatment, which implies the most sparing osteosynthesis in the early treatment of fractures, taking into account the stage of non-union in the complicated course of the fracture of the HMMC, and also helps to choose a rational method of treatment.
These data allow us to classify the study of HMMC fractures and their consequences as one of the important and urgent problems in pediatric traumatology, which is far from being finally solved. This situation requires further research into this topical problem.
Purpose of the study: To optimize diagnosis and improve treatment outcomes of humeral capitulum fractures and their consequences in children.
MATERIALS AND METHODS
The results of the examination and treatment of 120 children with fractures localized to the distal condyle of the humerus were analyzed. The patients' age ranged from 3 to 17 years. Boys accounted for 60% and girls 40%. Fractures (age of injury ranging from 5 to 12 days) in 75 patients, aged fractures in 45 patients (age of injury ranging from 13 to 60 days). Patients underwent open repair of the head of the condyle of thehumerus.General anaesthesia, patient positioned on the back. The arm is laid on a side table bent at the elbow at an angle of 90-1000. Skin incision on outer surface of the elbow joint, above the fracture, from the level of the neck of the radius to the
supramaxillary region of the shoulder. Upper corner of the wound avoids damaging the radial nerve. A soft tissue tear is exposed in layers and the haematoma is removed. The fracture is released from the shoulder to the distal side (so as not to cut through the muscular pedicle of the fracture). The clotted blood is removed from the joint. The fracture is repositioned. For fixation the first splint is guided from the lateral surface of the condyle head to the medial epicondyle. The other spoke is inserted at 300 or more, in relation to the first one. Layered catgut sutures, skin slit stitches, iodine treatment. Alcohol dressing.Immobilisation of hand with posterior plaster cast. When fixating the condyle head fracture, we attach importance to the direction of the first spoke: almost parallel to the articular surface (or perpendicular to the shoulder axis). In the described direction of the spokes, the angle between the spokes and the direction of the forearm muscles attached to the fracture is close to the right angle and their reflex spasm does not cause diastasis between the fractures, which contributes to a tight fixation.
STUDY RESULTS
In the post-operative period, patients with an immobilised arm are given an elevated position with a plaster cast. From the 2nd day movements in the fingers of the hand are prescribed. From day 5-7 in the shoulder joint. Movements of the elbow joint are prescribed according to age 2-3 weeks after the operation. We remove the spokes at 4 to 6 weeks after the operation. With the purpose of restoration of joint movements from 2-3 weeks patients receive electrophoresis of potassium iodide solution, ultrasound, massage of shoulder and forearm muscles.
CONCLUSION
The timely diagnostics and skilful application of operative methods of treatment of fractures of the humeral capitulum prevents complications such as incorrect fusion and non-union, pseudarthrosis. Fixation of fracture fragments of irregularly healed fractures with our modification allows to achieve stability and prevents secondary displacement.
REFERENCES
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