Fracture separation of the distal humeral epiphysis in children younger than three years old

This study evaluated the change of carrying angle and the causes of cubitus varus after the fracture separation of the distal humeral epiphysis in you ng children. Twelve cases of fracture separation of distal humeral epiphysi s were treated from January 1995 to July 1997. The age of all patients was younger than 3 years old. A metaphyseal fragment was seen in all cases (Sal ter-Harris type II), but the size of the metaphyseal fragment was either a very small flake or a large Thurston-Holland fragment. Posteromedial displa cement was seen in all cases. There were three treatment groups: closed red uction with percutaneous pinning, closed reduction with cast, and cast with out reduction. Follow-up period averaged 23.5 months (range, 12-40). Cubitu s varus deformity was seen in seven cases, and six of them had a partial de fect of the medial condyle that was avascular necrosis. The methods of trea tment, age of injury, and the type of epiphyseal injury had no influence on the development of cubitus varus, but avascular necrosis of the medial con dyle was related to the cubitus varus deformity (p < 0.05). The results of this study suggest that fracture separation of distal humeral epiphysis in young children is likely to produce cubitus varus deformity with the develo pment of avascular necrosis of the medial humeral condyle.