Osman Çimen, Kahraman Öztürk, Hüseyin Emre Akdeniz, Alper Köksal, Muhammed Mert, Deniz Kargın

Department of Orthopedics and Traumatology, Istanbul Metin Sabancı Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Türkiye

Keywords: Baumann’s angle, carrying angle, cubitus varus, elbow, infrafossal fracture, supracondylar.


Objectives: In this case series, we aimed to evaluate the clinical and radiographic outcomes of the patients with infrafossal fracture of the humerus and to evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire.

Patients and methods: Between January 2005 and July 2020, the clinical data and radiographs of 2,443 children who were treated due to distal humerus fracture were retrospectively analyzed. A total of six patients (5 males, 1 female; mean age: 6.7±2.6 years, range, 3 to 11 years) treated due to an infrafossal fracture of the humerus were included. Radiographic measurements, such as Baumann’s angle, lateral capitellohumeral angle, and carrying angle of the elbow, were performed. At the final follow-up, elbow joint range of motion (ROM) was measured, functional scores of the elbow and upper extremity were assessed. Complications were also recorded.

Results: The mean follow-up was 62.8±47.4 (range, 20 to 140) months. Two patients underwent open and three underwent closed reduction and internal fixation by different surgeons. One of the patients was treated with a long-arm cast. There was no major elbow ROM limitation. There was no significant deterioration in the lateral capitellohumeral and elbow carrying angles of the patients. Baumann’s angle was normal for all the patients; however, it could not be measured in two patients, as their epiphyses were closed. Four patients had an excellent MEPS and two patients a good MEPS. The QuickDASH scores were low in all patients. There were two patients with cubitus varus who were treated surgically using lateral closing-wedge corrective osteotomy.

Conclusion: Infrafossal fracture of the humerus is a fracture type which is different from supracondylar and transcondylar fractures and has not been previously reported in the literature. Despite the cubitus varus developed in two of our patients, functionally satisfactory results were achieved in all patients at the end of the treatment. Due to the risk of developing cubitus varus, patients with infrafossal fracture of the humerus should be followed closely until the end of adolescence. Although the current study is very limited in terms of being a guide for the treatment, it may contribute to the literature in terms of defining a new fracture subtype.

Citation: Çimen O, Öztürk K, Akdeniz HE, Köksal A, Mert M, Kargın D. Pediatric infrafossal fracture of the humerus: A case series. Jt Dis Relat Surg 2022;33(3):645-657.

Ethics Committee Approval

The study protocol was approved by the Health Sciences University Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital Medical Specialization Education Board (TUEK) (date: 20.08.2020, no: 61/436). The study was conducted in accordance with the principles of the Declaration of Helsinki

Author Contributions

Study design, writing the article: O.Ç.; Study design, and last control: K.Ö.; Radiological measurement: H.E.A.; Clinical evaluations of patients: A.K.; Radiological measurements, writing the article: M.M.; Last control, evaluating the patients: D.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.