Elbow In Children Research Articles

Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures.

Supracondylar humerus fractures (SCHFs) are the most common injuires of the elbow in children, often categorized by the Gartland classification. While type 1 and 2 fractures commonly managed conservatively, type 3 and 4 fractures typically require surgical treatment. Although closed reduction and percutaneous pinning have shown success, open reduction may be required in cases where adequate reduction cannot be achieved. This study aims to identify radiological and clinical risk factors associated with transitioning from closed reduction to open reduction in Gartland type 3 and 4 SCHF in children. We retrospectively analysed 159 patients operated on between 2014 and 2022 for Gartland type 3 and 4 SCHF. Parameters including age, gender, injury severity, time to surgery, neurovascular damage, medial spike angle, fracture-skin distance, medial-lateral deviation, rotation, fracture level, and Baumann angle were evaluated. A total of 159 SCHF in children aged 3 to 12 years, classified as Gartland type 3 (106 patients, 66.6%) and type 4 (53 patients 33.4%), underwent surgical intervention. Notably, 46 patients (28.9%) initially managed with closed reduction exhibited failure, prompting the necessity for conversion to open reduction. Injury severity, lateral deviation, advanced age, low medial spike angle, and low fracture tip-to-skin distance were found to be factors that could potentially increase the need for open reduction (P<0.05). Logistic regression analysis showed that the low medial spike angle, flexion type injury, and low fracture type increased the likelihood of open surgery (P<0.05). Sex, side, duration to surgery, and Baumann angle showed no significant associations. SCHF commonly necessitate surgical intervention in children. Although the risk factors for failed closed reduction and the need for open surgery have been discussed in the literature, there is no consensus. Preoperative planning, particularly for patients with specific factors like lateral deviation, advanced age, low medial spike angle, low fracture-to-skin distance and high injury severity, should consider potential open surgery requirements. Level III.

Paediatric supracondylar fractures: assessment and management.

Supracondylar fractures of the distal humerus are the most common fracture around the elbow in children. A thorough initial assessment must be conducted to identify any associated neurovascular injury and carefully documented. The assessment should include a vascular examination of the radial pulse, temperature, colour and capillary refill time. A neurological examination must comment on the motor and sensory function of the radial, median and ulnar nerves. X-rays allow an evaluation of the fracture location and type, and the degree of displacement. Immobilisation in plaster is the gold standard treatment for paediatric supracondylar fracture of the humerus where the degree of displacement is within acceptable parameters. Casting should be followed by orthogonal radiographs and a repeat neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge, and the child reviewed in a fracture clinic within 1 week of the injury. The British Orthopaedic Association Standards for Trauma and Orthopaedics for supracondylar fractures of the humerus in children are useful for junior orthopaedic and emergency medicine clinicians to refer to when dealing with these injuries.

Comprehensive Analysis of Pediatric Elbow Radiographic Lines and Angles.

The study aimed to determine relevant radiographic lines and angles of children's elbow. A retrospective cross-sectional study. Tertiary pediatric trauma center. X-rays of healthy children's elbows 0-18 years of age in whom the radiographic image of the elbow in 2 projections was read without signs of fracture and possible indirect signs of fracture, whereas the exclusion criterion was a clearly visible poor image projection. Gender, age [patients were divided into 6 groups-group 1 (0-3 years), group 2 (4-6 years), group 3 (7-9 years), group 4 (10-12 years), group 5 (13-15 years), group 6 (16-18 years)], side, intersection of the radiocapitellar line in the anteroposterior (AP) projection, intersection of the radiocapitellar line in the lateral projection, intersection of the anterior humeral line, Baumann angle, carrying angle, lateral capitellohumeral angle, shaft condylar angle, intersection of the coronoid line and radioulnar overlap. Two hundred elbows were evaluated. The radiocapitellar line in AP and lateral projections passed through the middle third of the capitellum in 74.5% and 93%, respectively. The anterior humeral line passed through the middle third of the capitellum in 88.5% of cases. When observing the proportion of radiocapitellar lines passing through the middle third of the capitellum in the AP, with increasing age an increasing proportion of lines pass through the middle third of the capitellum [from 8.3% in group 1 (0-3 years) to 94.1% in group 6 (16-18 years), P = 0.001] and lateral projection (from 50% in group 1%-100% in group 6, P = 0.023) and anterior humeral line (from 25% in group 1%-100% in group 6, P = 0.0001). The mean Baumman angle, carrying angle, lateral capitellohumeral angle, shaft condylar angle were 71.59 degrees, 10.97 degrees, 50.84 degrees, and 55.31 degrees, respectively. With age, the shaft condylar angle records the greatest increase (from 41.6 degrees in group 1-68.2 degrees in group 6, P = 0.000). A correlation was observed between Baumann angle and carrying angle (r = -0.674) and between Baumann angle and radioulnar overlap (r = 0.542). Considering the anatomical variability of children's elbow, radiologic measurements and their interpretation, in the context of timely diagnostics, must be approached with great caution, especially in younger age groups, because it is with them that the largest proportion of lines and angles do not follow established principles. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Protocol for Surgery or Cast of the EpicoNdyle in Children's Elbows (SCIENCE).

The management of fractures of the medial epicondyle is one of the greatest controversies in paediatric fracture care, with uncertainty concerning the need for surgery. The British Society of Children's Orthopaedic Surgery prioritized this as their most important research question in paediatric trauma. This is the protocol for a randomized controlled, multicentre, prospective superiority trial of operative fixation versus nonoperative treatment for displaced medial epicondyle fractures: the Surgery or Cast of the EpicoNdyle in Children's Elbows (SCIENCE) trial. Children aged seven to 15 years old inclusive, who have sustained a displaced fracture of the medial epicondyle, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb score, pain measured using the Wong Baker FACES pain scale, and quality of life (QoL) assessed with the EuroQol five-dimension questionnaire for younger patients (EQ-5D-Y) will be collected. Each patient will be randomly allocated (1:1, stratified using a minimization algorithm by centre and initial elbow dislocation status (i.e. dislocated or not-dislocated at presentation to the emergency department)) to either a regimen of the operative fixation or non-surgical treatment. At six weeks, and three, six, and 12 months, data on function, pain, sports/music participation, QoL, immobilization, and analgesia will be collected. These will also be repeated annually until the child reaches the age of 16 years. Four weeks after injury, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the PROMIS upper limb score at 12 months post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardians. The NHS number of participants will be stored to enable future data linkage to sources of routinely collected data (i.e. Hospital Episode Statistics).

Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children

IntroductionLateral humeral condyle fractures (LHCFs) are the most common intra-articular fracture occurring at the elbow in children. Conventional treatment for displaced pediatric LHCFs is open reduction and percutaneous pinning, and few studies have regarded the efficacy of arthroscopic-assisted techniques. We aimed to evaluate the efficacy of anatomic reduction via elbow arthroscopy for pediatric humeral lateral condyle fractures with displacements >4 mm. MethodsA total of 32 children with LHCFs featuring displacements >4 mm were enrolled in this retrospective study. Arthroscopically assisted reduction was performed as the primary treatment approach. For simple displaced fractures, arthroscopically assisted reduction was directly employed with intermittent intra-articular irrigation. For fractures with distal fragment rotation, the rotated fragments were firstly realigned into a simple displaced position under fluoroscopy before proceeding with arthroscopy. The success rate of arthroscopically assisted reduction and clinical outcomes at the latest follow-up were assessed, and complications related to the procedure were monitored. ResultsTwenty-nine of 32 (90.62 %) enrolled cases were successfully treated with arthroscopically assisted reduction. Failure cases were attributed to soft tissue swelling, which hindered the manipulation of the fracture fragments for reduction or fixation. We subsequently adapted the surgical procedure, resulting in a significant increase in the success of arthroscopically assisted reduction, rising from 71.43 % to 96 %. Among the 29 successfully treated cases, excellent functional outcomes were observed in 18 cases, and 11 cases showed good outcomes. Regarding the carrying angle outcomes, 28 patients achieved excellent results, with one patient having a good outcome. The most frequent radiographic finding after surgery was lateral spur formation without further negative effects. Only one case of superficial infection occurred, promptly healing with topical management. No significant complications such as neurovascular injury or compartment syndrome were observed. ConclusionArthroscopically assisted anatomic reduction provides a promising alternative to open reduction for LHCFs with displacements exceeding 4 mm, offering direct visualization of the articular surface and minimizing soft tissue dissection.

"Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes.

The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury). A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up. Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%. The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations. level III.

Floating elbow in children: Factors associated with serious complications

Objectives: Simultaneous ipsilateral humerus and forearm fractures are rare injuries commonly caused by high-energy trauma. They are known for their higher potential for complications than isolated injuries on the same sites. There is no standardized management nor universally accepted classification for this condition. This study aimed to describe our experience with these injuries. Methods: This is a retrospective study of consecutive cases treated from June 2018 to December 2022. The following variables were assessed: age, sex, affected side, mechanism of injury, type of humeral fracture, type of forearm fracture, presence of bone exposure, associated injuries, treatment performed, complications, and elbow functionality according to the Mayo Elbow Performance Score (MEPS). Results: Thirty-four cases were analyzed, 58.8% of which were male. The mean age was 6.7 years (6 months–15 years). The most frequent mechanism was spin cycle rotatory injuries. The most affected location in the humerus was the diaphysis (55.8%), and 79.4% of fractures involved both forearm bones. Open fractures accounted for 23.5% of the cases. Regarding the treatments performed, fixation of at least one bone was performed in 32 cases (94%), and both sites were fixed in 24 cases (70.5%). Complications occurred in 26.5% of cases, of which 8.8% were compartment syndromes, and no implant-related infections were reported. All compartment syndromes were related to the torsion trauma caused by the spin cycle rotatory injuries. Elbow function graded according to the MEPS was excellent in 50% of patients. Conclusion: Floating elbow injuries are rare serious injuries. Spin cycle rotatory injuries further increase the complexity of treatment and the potential for complications.

91 Introduction of a Simple Proforma Improves Documentation of Neuro-Vascular Status in Paediatric Supracondylar Humerus Fractures (Closing Loop Audit)

Abstract Introduction Supracondylar fractures of the humerus are the most common fracture around the elbow in children. There is a risk of significant complications including nerve injury, vascular compromise, compartment syndrome and clinical deformity. BOAST (British Orthopaedic Association Standards for Trauma) published guideline 11 in 2014 (updated in Oct 2020) which lists criteria that should be assessed and documented for each child with this injury. Aim Assess whether an introduction of a simple proforma will Improve documentation of the neuro-vascular status in paediatric supracondylar humerus fractures. Method a closing loop Audit to review the accuracy of documentation of the neuro-vascular status in the admission clerking against the standards published in the updated BOAST guidelines both before and after introduction of a simple documentation proforma. Results In the first audit cycle 30 patients were included and detailed documentation of the Neuro-vascular status as per the BOAST guideline was less than 40 %. After the proforma was introduced, the second closing loop cycle included 31 patients and detailed documentation of the Neuro-vascular status as per the BOAST guideline was 70 %. Conclusions The introduction of a simple proforma has improved significantly the documentation of the neurovascular status in children presenting to the ED with a supracondylar humerus fracture.

Diagnostic imaging for elbow TRASH lesions in children and usefulness of ultrasonography using standard planes.

Fractures around the elbow in children should be carefully evaluated because the main portion is cartilaginous, and radiographs are not completely reliable. This study aimed to assess the diagnostic imaging for pediatric elbow fractures that require special attention and consider the usefulness of ultrasonography with seven standard planes for the diagnosis. Patients diagnosed with elbow fractures wherein TRASH (The Radiographic Appearance Seemed Harmless) lesions were evaluated retrospectively. The diagnoses on initial radiographs, final diagnoses, additional imaging excluding radiographs, and the treatments were investigated. The standard planes for ultrasonography to detect elbow fractures included an anterior transverse scan at the level of the capitellum and proximal radioulnar joint, an anterior longitudinal scan at the level of the humeroradial and humeroulnar joints, a longitudinal scan along the lateral and medial border of the distal humerus, and a posterior longitudinal scan at the level of the distal humerus. A total of 107 patients with an average age of 5.8 years (range, 0-12 years) at the time of diagnosis were included. Of 46 (43.0%) patients misdiagnosed at the initial radiograph, 19 (17.8%) needed additional treatments due to inappropriate initial management. Ultrasonography using the standard planes was useful for prompt diagnosis and appropriate treatment. Prompt and appropriate evaluation with ultrasonography can prevent the mismanagement of pediatric elbow injuries. Level of evidence: Level IV-retrospective case series.

PROTOCOL FOR EXAMINING TRANSFER VALIDITY OF A SUPRACONDYLAR HUMERAL FRACTURE PINNING AUGMENTED REALITY SIMULATOR

Augmented reality simulators offer opportunities for practice of orthopaedic procedures outside of theatre environments. We developed an augmented reality simulator that allows trainees to practice pinning of paediatric supracondylar humeral fractures (SCHF) in a radiation-free environment at no extra risk to patients. The simulator is composed of a tangible child's elbow model, and simulated fluoroscopy on a tablet device. The treatment of these fractures is likely one of the first procedures involving X-ray guided wire insertion that trainee orthopaedic surgeons will encounter. This study aims to examine the extent of improvement simulator training provides to real-world operating theatre performance.This multi-centre study will involve four cohorts of New Zealand orthopaedic trainees in their SET1 year. Trainees with no simulator exposure in 2019 - 2021 will form the comparator cohort. Trainees in 2022 will receive additional, regular simulator training as the intervention cohort. The comparator cohort's performance in paediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a six-month period. The performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to examine whether additional training with an augmented reality simulator shows improved real-world surgical outcomes compared to traditional surgical training. This protocol has been approved by the University of Otago Health Ethics committee, and the study is due for completion in 2024.This study is the first nation-wide transfer validity study of a surgical simulator in New Zealand. As of September 2022, all trainees in the intervention cohort have been recruited along with eight retrospective trainees via email. We present this protocol to maintain transparency of the prespecified research plans and ensure robust scientific methods. This protocol may also assist other researchers conducting similar studies within small populations.

Outcome of Pediatric Comminuted Open Supracondylar Humerus Fracture

Abstract Introduction: Supracondylar humerus fracture is the most common fracture around the elbow in children. Closed fractures of the supracondylar humerus are ostensibly more common compared to open injuries. Though closed reduction and pinning are often feasible for Gustilo Anderson Grade 1 open fractures, surgical debridement followed by open reduction and pinning or JESS fixator application may often be required in open supracondylar humerus fractures with higher Gustilo Anderson grades. Materials and Methods: A retrospective study was conducted from 2018 to 2022 on children with open comminuted supracondylar humerus fractures. Open fractures were classified as per Gustilo Anderson’s classification, and fracture patterns were described as per modified Gartland’s and AO classifications. All patients were treated with closed or open-assisted reduction and fixation. Children were reviewed at the third/fourth and eighth weeks and later at 6 months and one year for the cosmetic and functional outcome assessment by Flynn criteria. Orthogonal elbow radiographs were obtained to assess radiographic parameters at each visit, including the final follow-up. Result: Six children with a mean age of 8.3 years (3–12 years) were treated during the study period. One child had grade 3A, two had grade 2, and three had grade 1 open fractures, according to Gustilo Anderson’s classification. The mean duration from injury to presentation was 36.3 h. The mean time from presentation to surgery was 3.3 h (1–5 h). The mean follow-up period was 9.6 months (6–12 months). Four children had excellent outcomes, whereas one child each had fair and poor results according to Flynn’s functional outcome criteria. Conclusion: Children with comminuted open supracondylar humerus fractures with an unusual mechanism of injury and presenting early since injury had better functional outcomes on follow-up as compared to children presenting late, with associated complications undergoing the same.

Supracondylar Displaced Fracture of Elbow in Children Treated with Closed Reduction and Percutaneous K Wire Fixation

Objective: To compare the closed reduction and percutaneous K wire fixation method outcomes in the treatment of supracondylar displaced fracture of elbow in children. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, Arif Memorial Teaching Hospital, Lahore from 2nd April 2021 to 31st September 2021. Methodology: One hundred and seventy children were included. Those children having supracondylar displaced fractures of elbow with a grade 3 were included in the study as participant. K wires of 1.5-2cm were used after closed reductions were satisfactorily achieved. Padded-Back slabs at posterior position of elbow were applied. At 2 weeks’ suture removal and pin configuration was also observed. Callus production was observed through radiological x ray images. Results: Majority of the children belonged to the age group of 6-10 years. There were 59.4% males while 40.58% were females. Within the total number of cases 55% were administered two lateral parallel K wires while 45% were administered cross K wire. Pin tract infection was formed in 2.5% of lateral K wire cases while it was observed in only 1.2 % of Cross wire cases. Most of the children got the fracture while playing a sport. The recovery phase was of 3.5 months while fracture joined in a mean value of 1 month. Conclusion: Lateral percutaneous pin technique for the management of supracondylar fracture of humerus bone is a more suitable method and offers same results without involvement of iatrogenic ulnar nerve injury. Keywords: Humerus, Ulnar nerve, Pin method, K-wire, Deformation

Outcomes of Percutaneous Cross K-Wire Fixation for the Management of Supracondylar Displaced Fractures of Elbow in Children

Background: It is estimated that about 16–17 percent of all fractures in pediatric patients are supra-condylar fractures of the elbow. Different techniques are used for the management of supracondylar displaced fractures of elbow in children. Objective: To find out the outcomes of percutaneous cross- K-wire fixation for the management of supracondylar displaced fractures of elbow in children Methodology: This descriptive cross sectional study was carried out at Orthopedic Department of Khyber Teaching Hospital Peshawar for duration of one year from June 2021 to July 2022. A total of 80 patients were included in the current study. All the patients were followed for up to six months. At last follow-up, all patients were evaluated using Flynn's criteria. All the data analysis was done by using IBM SPSS version 23. Results: On the basis of Flynn’s criteria, excellent results were observed in 54 (67.5%) patients, good results in 20 (25%) patients, fair results in 4 (5%) patients while poor results were observed in 2 (2.5%). Based on the post-operative associated problems, pin-tract infections were observed in 7 (8.75%) patients, cubitus varus deformity was observed in 2 (2.5%) and temporary ulnar nerve deficit was observed in 5 (6.25%) patients. Conclusion: Our study concludes that in children, type-II &amp; III supra-condylar displaced fracture of elbow can be managed easily and effectively with a low rate of complications. Keywords: Percutaneous cross- K-wire fixation; Supracondylar displaced fractures; Elbow

Floating Elbow in Children: About 3 Cases

Introduction: We aimed to discuss through a description of three cases of floating elbow in children the management and outcome aspect. Observations: Case 1: 11-year-old boy. Admitted for for a left floating elbow made by a stage III supracondylar fracture associated with a fracture of both bones of the forearm. He was managed by surgery (K-wire) for both fractures. Case 2: 4-year-old girl admitted for bilateral floating elbow made by a fracture of the external condyl, associated with a fracture of both bones of the forearm on the right side. In the left upper limb a fracture of the upper extremity of the humerus, stage IV supracondylar fracture and, epiphyseal detachment of the radius. She under-went an orthopaedic reduction for the epiphyseal radial detachment and surgical treatment of the other fractures. Case 3: 7-year-old patient admitted following a roadway accident, with the lesion assessment of a fracture of the humerus associated with a fracture of the olecranon, of the radial head and diaphyseal fractures of the two bones of the forearm. She received surgical treatment for all of her injuries. With a follow-up of 15 months, the evolution was considered satisfactory. Conclusion: The floating elbow is both a rare and a complex pathology in children, which combines several concomitant lesions of different severity and prognosis. A precise lesion assessment is necessary for an adequate treatment.

Anterior trans-olecranial dislocation of the elbow in children: A case report of an unusual form of elbow dislocation and review of literature.

• Trans -olecranial fracture-dislocations are rare injuries in children. • It's a real therapeutic emergency. • Periosteum incarceration needs to be considered if closed reduction failed. • Treated early, the results are good.

The characteristics and treatment strategy for transolecranon fracture-dislocation of the elbow in children: a retrospective study

BackgroundTransolecranon fracture-dislocation of the elbow is rarely seen in children. The purpose of this retrospective study was to discuss the pathological characteristics and treatment strategy for this injury in children.MethodsFrom October 2016 to March 2019, 15 patients seen and treated at our institutions for transolecranon fracture-dislocation of the elbow were identified, and their medical records and radiographs were reviewed retrospectively. There were 11 boys and 4 girls, with an average age of 8.3 years (from 5 to 14 years). The left arm was involved in 10 cases, and the right arm was involved in 5 cases. Type I (simple fracture) was found in 11 cases, and type II (comminuted fracture) was found in 4 cases, 3 of which with coronoid process involved. Closed reduction was successful under local anaesthesia in 14 cases but failed in 1 case. In 11 patients with type I fractures, 10 received fixation of Kirschner wire and tension band, and one patient underwent bone plate fixation. In 4 patients with comminuted fractures (type II), internal fixation was performed with Kirschner wires combined with reconstruction plates.ResultsThe 15 patients were followed up for 24 to 48 months (average, 30.2 months). The final evaluation showed fine anatomical relationship of the elbow in all with no complications observed. Failure of internal fixation did not occur in any patient. The fractures acquired bony union in all patients after 8 to 12 weeks (average, 9.6 weeks). The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score (MEPS) as excellent in 11 cases, good in 3 cases and fair in one case.ConclusionsAs a type of complicated fracture-dislocation of the elbow, the transolecranon fracture-dislocation is rare in children. The fracture is mainly simple type. Treatment options depend on the type of fracture-dislocation. Only anatomical reduction of the olecranon fracture and restoration of a normal trochlear notch can lead to a stable humeroradial joint and good clinical efficacy.

Functional and radiological outcome of gartland type 2 and 3 supracondylar fracture humerus in children treated by percutaneous pinning

Supracondylar fracture of Humerus is the commonest injury around the Elbow in children. It constitutes about 60% of all the fractures about the Elbow in children. The aim of the present study is to evaluate the results of percutaneous pinning of unstable or irreducible Type II and III Supracondylar Humeral fractures in children. A prospective study was conducted on 30 children, taking into consideration age, gender, affected side, mode of injury, type of fracture, Gartland classification of fractures, time duration between injury and surgery, postoperative complications and radiographic and clinic variables.: The median loss of motion was 5 degrees and the median change in carrying angle was 4 degrees. All patients had satisfactory results in terms of Loss of Carrying angle, Limitation of Elbow flexion and Flynn’s grading. There were 19 patients that had excellent ratings, 9 patients had good ratings and lastly only 2 patients had fair Flynn’s ratings. There was only 01 patient suffering from neurological deficit and only 01 patient from pin track infection. Percutaneous fixation with two crossed Kirschner wires leads to good functional and radiological outcome of Gartland type 2 and 3 supracondylar fracture humerus in children.

Translated article] Fractures of the lateral condyle of the humerus associated with elbow dislocation in children. A systematic review of the literature

BackgroundLateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for paediatric lateral condyle humerus fractures associated to elbow dislocation. MethodsA systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. ResultsThe initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2 out of 10 patients. ConclusionsCurrent evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.

Lateral humeral condyle fracture with dislocation of the elbow in children: a report of two cases

Lateral humeral condyle fracture with dislocation of the elbow in children: a report of two cases

Fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Una revisión sistemática de la literatura

BackgroundLateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. MethodsA systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. ResultsThe initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients. ConclusionsCurrent evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.