Functional outcome of the elbow in toddlers with transphyseal fracture of the distal humerus treated surgically

PURPOSE: To quantitatively evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) in children with transphyseal fracture of the distal humerus (TFDH) treated surgically. METHODS: During the period between 2005 and 2015, a total of 16 patients (ten male, six female) met the inclusion criteria. Mean age at the time of injury was 18 months (11 to 37) and mean follow-up was 42.3 months (6 to 98). Based on a modified version of Delee’s classification (Group A to C), the clinical and radiographic outcome of TFDH in toddlers treated surgically were retrospectively evaluated. RESULTS: Mean humeral-ulnar (HU) angle of the injured and non-injured side was 1.2° (-18° to 14°) and 8.8° (2° to 19°), respectively (p = 0.001). Closed and open reduction showed similar HU angle values (p = 0.682). Mean MEPS score of the injured and non-injured side was 85.5 points (70 to 95) and 95 points (90 to 100), respectively (p = 0.002). No significant association was identified between MEPS score and gender, side, age at trauma, direction of displacement, time from trauma to surgery, presence of ossified capitellum, type of surgery and type of fracture. CONCLUSION: Functional outcome was generally good regardless of surgical procedure performed, closed or open and type of fracture according to modified Delee’s classification. However, a residual cubitus varus was commonly observed among toddlers with transphyseal fractures of the distal humerus. LEVEL OF EVIDENCE: Level IV – Therapeutic study