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The increased level of injuries and the prevalence of orthopedic pathology requires the improvement of diagnosis and treatment of diseases of the support and movement system. Today, the treatment of fractures in the distal metaepiphysis of the humerus in childhood and adolescence is one of the most common injuries, accounting for 16-50% of bone fractures in general and 50-80% of all intra-articular injuries of the upper limb. Supracondylar (3-18%) and transcondylar (57.5-70%) fractures prevail among injuries of this localization, mainly in children from 5 to 9 years old. An important stage of diagnosis is establishing the type of damage, which determines the choice of method and method of treatment. The determination of possible accompanying neurological and vascular disorders, late diagnosis and treatment of which lead to limb function disorders are of great importance. The objective: to improve the diagnosis of injuries in supracondylar fractures of the humerus in children and adolescents by forming a clinical and diagnostic algorithm. Materials and methods. The analysis of data from the scientific literature (Pubmed, Up-to-date, Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health) and the results of a comprehensive examination and treatment of 123 children and adolescents with supracondylar fractures of the humerus during the period from 2019 to 2023 were carried out, on the basis of which an algorithm was created for a step-by-step comprehensive assessment of the patient's condition and associated injuries with the specified fractures. Results. Clinical-instrumental diagnosis of supracondylar fractures of the humerus and accompanying neurovascular injuries is based on knowledge of the peculiarities of childhood anatomy and psychoemotional characteristics of patients of this age group. Based on the analysis of data from the literature and own observations, an algorithm for comprehensive assessment of patients is proposed. Conclusions. In order to establish a diagnosis and determine accompanying neurovascular complications in children and adolescents with supracondylar fractures of the humerus, it is necessary to conduct a complex of clinical and radiological examinations. The developed "Clinical-instrumental diagnostic algorithm for supracondylar fractures of the humerus in children and adolescents" includes the determination of concomitant neurovascular disorders. Its use allows to reduce the number of diagnostic errors and providing effective treatment of patients with this pathology. [ABSTRACT FROM AUTHOR]

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation con-figurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct. [ABSTRACT FROM AUTHOR]

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