Unfortunately, in most circumstances, the characteristics of MDJ fractures are not currently recognized by all colleagues, and some MDJ fractures are still being treated with the same modality as typical supracondylar humerus fractures, which has caused more complications such as higher incidence of need for open procedures and loss of fixation ( 9, 13).
Icd 10 code closed supracondylar fracture elbow manual#
The main reason for these difficulties is that the fracture line of MDJ fracture is above the olecranon fossa, making it difficult to obtain adequate stability during manual reduction because the cross-sectional area is much smaller than that in the supracondylar region, and the pins tend to cross through the higher fracture site with a route nearly parallel to the humeral axis, which may lead to the decrease of fixation stability ( 12). MDJ fractures are problematic to treat because of their instability and tendency to develop post-operative complications ( 8, 9, 11). The MDJ fracture in children is rare, and it accounts for only 3.3% of displaced fractures at the distal humerus ( 9, 10). This kind of atypical supracondylar fracture has been defined as a distal humeral metaphyseal-diaphyseal junction (MDJ) fracture ( 7, 8). Briefly, it recommends non-surgical immobilization for non-displaced fractures and closed reduction with percutaneous pinning for displaced fractures ( 6).Ī specific variant of humeral supracondylar fracture has been reported in which the fracture line crosses just proximal to the olecranon fossa. At present, a normalized treatment algorithm for the fracture has been established ( 3– 5). The humeral supracondylar fracture is the most common elbow fracture in children ( 1), accounting for 55–75% of elbow fractures in children ( 2). At last follow-up, both groups obtained satisfactory clinical and radiographic outcomes.Ĭonclusion: MDJ fractures can be reduced successfully and fixed stably via a novel CRPP technique, and laborious and frustrating attempts at closed reduction and further open reduction can be avoided. The average duration of the surgery in Group A was significantly shorter than that in Group B ( p < 0.001). Children with successful CRPP in each group were included to compare the efficacy of the novel CRPP technique. In group B, five of the eight fractures were treated successfully with the conventional CRPP technique three fractures needed open reduction, and one of them had further surgery because of the loss of fixation. No complications such as pin-site infection or iatrogenic nerve injury were found in this group.
Results: In Group A, all six MDJ fractures were treated successfully with the novel CRPP technique without the need for open procedures or re-operation. Clinical and radiographic outcomes in the two groups were then compared. Eight children underwent the conventional reduction maneuver utilized in supracondylar fracture and were enrolled as Group B. Six children who underwent treatment with a novel CRPP technique were enrolled as Group A. Methods: We retrospectively evaluated 14 children (8 boys and 6 girls) who underwent closed reduction and percutaneous fixation for the treatment of MDJ fractures. The purpose of this study was to evaluate a novel closed reduction and percutaneous pinning (CRPP) technique for the treatment of these fractures. Closed reduction and fixation are challenging and may not be possible with the conventional reduction maneuver utilized in supracondylar fractures. Objective: The metaphyseal-diaphyseal junction (MDJ) fracture is an uncommon but problematic type of fracture occurring at the distal humerus in children. 2Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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