An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

Abstract

Background. The Salter-Harris II fracture is the most common transphyseal fracture of all types of fractures, per-total and for each bone extremity that has a growth cartilage. This type of fracture rarely occurs in the humeral palette and the metaphyseal fragment is located laterally or medially. No cases with ventral or dorsal metaphyseal fragment have been described.

Purpose. To bring into notice a fracture, type Salter-Harris II, with posterior metaphyseal fragment, represented by a posterior corticospongiosis lysereum(thickening) and the olecranon fossa, associated with periosteal rupture and soft tissue interposition.

Study design: Case report

Methods: A 9-year-old patient shows signs of traumatic injury, as a result of a direct impact on the right elbow. After a radiological examination, the diagnosis of Gartland type III supracondylar fracture is established, a closed reduction is practiced and it is immobilized in a plaster cast. The radiological control after the orthopedic reduction highlighted an unsatisfactory reduction. A surgery and an open reduction and internal fixing in "double X" were performed.

Results: The preoperative diagnosis of Salter-Harris II fracture, with posterior Holland fragment, was made with difficulty and may be a surprise on intraoperative exploration. Open anatomical reduction and the fixation in "double X" allowed a firm synthesis of the fracture, verification of stability, intraoperatively, lack of mobilization in the plaster splint, starting recovery on the first postoperative day and full recovery of elbow mobility in 32 days.

Conclusions: Salter Harris type II fracture with posterior fragment dislocated by tilting, translation and asymmetric rotation, irreducible is operated by open reduction and internal fixation. The fixation in "double X" ensured a better stabilization and allowed the recovery of flexion and extension in 32 days from surgery.