Free Vascularized Iliac Crest Bone Graft for the Treatment of a Pediatric Lateral Humeral Condyle Fracture Nonunion: A Case Report.

Abstract

Fractures of the lateral humeral condyle are the second most common pediatric elbow fracture1, and they account for 15% of all pediatric elbow fractures2. In lateral humeral condyle fractures that were treated closed, 28.5% developed nonunion, while all fractures that were treated open healed2,3. These fractures are one of the few in children in which nonunion is a relatively common complication2,3. The algorithm for treating an established nonunion includes open reduction and internal fixation (ORIF) with bone-grafting4. To our knowledge, there is no literature demonstrating the percentage of treated nonunions that remain ununited, although this has been reported as a complication5. It is our experience that if the persistent nonunion is not treated, it can lead to progressive cubitus valgus deformity, elbow instability, and pain in adolescence and adulthood, without surgical options to treat this problem in adulthood6. This case report describes a successful option for providing union of the lateral humeral condyle in a patient with continued nonunion after ORIF and bone-grafting. The patient was informed that data concerning her case would be submitted for publication, and both the patient and her mother provided consent. A ten-year-old right-hand-dominant girl presented to our institution with symptoms of increasing pain and valgus deformity in the left elbow. Eight years prior, she had fallen on an outstretched arm and sustained a lateral humeral condyle fracture, which was treated nonoperatively. The fracture did not heal, and she had developed pain and deformity in the elbow. One year prior to presentation to us, an orthopaedic surgeon had performed a traditional in situ ORIF with iliac crest bone-grafting. On presentation to us, she had tenderness over the lateral humeral condyle. Elbow motion was 0° to 140°, pronation …