Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children

Gopal Gnawali,Indra Dhakal,Rajendra Sanjel Chhetri

doi:10.31729/jnma.3337

Abstract

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children. We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria. We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united. Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.

Highlights

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children
Late presentation of displaced lateral condyle fracture is often seen in Nepal mainly due to initial misdiagnosis and mismanagement
Fracture associated with other fracture or dislocation of elbow and age more than 12 years were excluded from the study

Summary

Introduction

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children. Late presentation of displaced lateral condyle fracture is often seen in Nepal mainly due to initial misdiagnosis and mismanagement. When presented late there is dilemma between conservative versus operative management due to fear of complications like avascular necrosis.[1,2] Recently many advocate for operative management to avoid nonunion, deformity, loss of elbow motion and tardy ulnar palsy like complications.[3,4,5]. Late presented displaced fracture is difficult to reduce anatomically due to fibrosis, sclerosis and shortening of common extensor, lengthening of common extensor with multiple incisions helps to achieve reduction.[7,8]

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Results

Discussion

Conclusion