The entire distal humeral metaphyseal separation fractures is a special injury of elbow joint in children. Due to the incomplete ossification of distal humerus in this age group, it is hard to clearly show the distal humerus by ordinary X-ray, which brings difficulties to diagnosis and treatment and is also prone to complications. With the development of arthrography technology and minimally invasive treatment of supracondylar fracture of humerus, the treatment as well as the effect has improved, and the related reports are few.

To investigate the surgical technique and efficacy of arthrography combined with single closed reduction in the treatment of entire distal humeral metaphyseal separation fractures in children.

From January 2017 to January 2020, the clinical data of 43 children (32 males and 11 females) with entire distal humeral metaphyseal separation fractures were retrospectively analyzed. There were 37 cases of extension-ulnar type and 6 cases of extension-radial type. The ages ranged from 1 year 5 months to 4 years and 2 months, with an average age of 2 years and 8 months. There were 18 cases of high fall damages and 25 cases of sports injuries. The time from injury to operation was 12 to 34 hours, with an average of 20.5 hours. Arthrography combined single closed reduction were applied with Kirschner wire and plaster fixation by the assistant. In the 3rd, 6th, and 9th month after operation, Flynn elbow clinical function score was used to evaluate the curative effect.

The operation time was (32.8±10.6) min, and the the X-ray frequency was (10.5±3.2) times. The average hospital stay was 4 days (3-7 days) . The average follow-up time was 18.4 months (9-36 months) . The X-ray showed fracture healing 3 to 4 weeks after operation, and then the plaster and Kirschner wire were removed. According to Flynn elbow clinical function score, the excellent and good rates were 81.4% (35/43) in the 3rd month and 88.3% (38/43) in the 6th month postoperatively. No complications such as osteofascial compartment syndrome, vascular and nerve injury, skin necrosis or nail tract infection occurred.

Intraoperative arthrography of the elbow joint can clearly show the cartilage of distal humerus, and help guide the treatment of entire distal humeral metaphyseal separation fractures with single closed reduction and minimally invasive fixation. It can directly judge the effect of reduction and guide the percutaneous insertion of Kirschner wire, which obtains satisfactory therapeutic effect. This method is relatively simple to operate, easy to grasp, effective, conducive to the early recovery of elbow joint function, and worthy of promotion.