English

Abstract

BACKGROUND: Neglected fracture of the lateral condyle of distal humerus in children is very common. Patients with non union of the lateral condylar fracture have pain, instability or a progressive cubitus valgus deformity, condylar prominence. A neglected displaced lateral humeral condyle fracture remains a difficult problem to treat. The bone ends become indistinct and soft tissue becomes contracted; making anatomic reduction difficult. Moreover an attempt to mobilize the fragment by stripping the soft tissues may lead to avascular necrosis. Several authors have recommended operative treatment for such patients, while others do not recommend operative intervention because stiff elbow and AVN are the usual outcomes. The present study was undertaken to assess the results of open reduction and internal fixation in neglected lateral humeral condyle fracture in children. MATERIAL AND METHODS: This is a prospective study carried out between November 2008 and July 2011 in the department of orthopedics at Teerthanker Mahaveer Medical College and research centre, Moradabad. Eighteen patients (14M:4F) with an average age of 7.3years (range 5.5 to 14 years) who had lateral humeral condyle fracture and reported 3 or more weeks after sustaining injury, were included in the study. The fractures were classified according to the Jacobs system. All patients were operated using the lateral approach and fixation was done using K wire or screw with or without bone grafting. The results were graded as excellent, good, fair or poor according to the modified criteria of Agarwal et al. RESULTS: There were 14 males and 4 females with a mean age of 7 years and 3 months (range 4-14 years). Among the nine (50%) patients who presented between 5 to 8 weeks after injury, the results were excellent in 3, good in 4, fair in 1 and poor in 1 patient. Excellent to good results were seen in all the five (27%) patients presenting between 3-5 weeks of injury. Among four (23%) patients out of total 18 patients who presented between 9-12 weeks of injury, 2 had poor results and 1 each had good and fair results. Maximum number of patients had Jacobs type 2 fractures. In our study 25% of these patients had showed excellent results, whereas only 12.5% of patients with type 3 fracture showed excellent results. Fourteen (n=14) patients underwent internal fixation with K wire and in four patients’ fixation was done by cancellous screws. The commonest complication seen was pin tract infection (n=10), followed by occasional pain (n=5) around the elbow. There were no cases of avascular necrosis. CONCLUSION: Satisfactory functional results can be obtained even in late presenting fractures lateral condyles of the humerus in children with modification of surgical technique.