Condyle Of Humerus Research Articles

Lateral Humeral Condyle Fracture in Childhood: Results of a New Surgical Technique.

Fractures of the lateral condyle of the humerus are one of the most common fractures in children, accounting for between 10% and 20% of fractures involving the elbow, with a peak incidence at 6 years of age. Treatment is often surgical for displaced fractures > 2 mm, according to Milch and Jakob classification. There is no consensus in the literature about the appropriate surgical management of these fractures. Objectives: The aim of this study is to describe, propose, and evaluate outcomes and complications of the surgical technique of reduction and osteosynthesis using trans-bone suture with resorbable threads. Methods: Patients with lateral condyle fractures treated with this surgical technique from 2015 to 2019 were included in this retrospective study, with a minimum follow-up of 24 months. For clinical and functional assessment of the elbow, Mayo Elbow Scores were recorded; we assessed the time of fracture healing, carrying angles, and Baumann angle of the affected limb compared to the healthy contralateral elbow for radiographic data. Complications have also been described. Results: We achieved satisfactory results; 36 patients with lateral condyle fractures were included in this study. Radiological healing was achieved in all cases. There was only one complication. No cases required additional surgical procedures. Almost all patients achieved a complete flexion of 110 degrees or more and complete extension. Conclusions: This surgical technique has good functional outcomes and fracture healing, a lower incidence of complications when compared to other surgical techniques, and no mechanical failure with good clinical and radiological results.

Fractures of the lateral condyle of the humerus in children : High risk of secondary dislocation with conservative treatment

Fractures of the lateral condyle of the humerus in children are articular fractures with difficult diagnostics due to the incompletely ossified elbow joint. The aim of this study was to evaluate the method of treatment at initial presentation and to analyze the frequency of subsequent displacement during follow-up. Retrospective analysis of the frequency of primary fracture dislocation and subsequent displacement of fractures of the lateral condyle of the humerus in children under 16years of age between 2004 and 2021. Conventional radiographs in two planes at the time of the accident and in the follow-up after 5-7days were evaluated. Atotal of 285 fractures of the lateral condyle of the humerus were evaluated. The average age was 5.3years. Of the fractures 109 (38.3%) were directly surgically treated in cases of primary displacement and 176 fractures (61.7%) were not primarily displaced and were initially treated conservatively. During follow-up, subsequent displacement was evident in 46fractures (26.1%). Atotal of 130 fractures (45.6%) were treated conservatively and 155 fractures (54.4%) were treated surgically using open joint visualization and screw osteosynthesis or K‑wire osteosynthesis. Fractures of the lateral condyle of the humerus occur more frequently in acertain age group and require targeted radiological diagnostics. Nondisplaced fractures can be treated conservatively but essential radiological follow-up shows ahigh number of subsequent displacements, so that open surgical stabilization is often necessary.

Osteochondroma of the distal humerus: A rare location

Osteochondroma of the medial condyle of the humerus is rare; hence, diagnosis can be challenging as it may be confused with other causes of swelling around the elbow joint. This can lead to compression of neurovascular structure. We present a case of left medial condyle humerus osteochondroma with ulnar nerve involvement and conduct a literature review of this rare condition. A 25-year-old male patient presented with swelling around the left elbow joint for 1 year and tingling and numbness along ulnar nerve distribution for the last 3 months. He underwent an X-ray, magnetic resonance imaging, electromyography, and nerve conduction velocity that confirmed the diagnosis of an osteochondroma with ulnar nerve involvement. An excisional biopsy was subsequently done. In conclusion, the case is an atypical location of osteochondroma. The history, clinical presentation, diagnostic imaging, and management outlined may help in the early identification and management of this rare but complicated condition.

Possible Mechanism and Treatment Results of Combined Pediatric Fractures of the Humeral Lateral Condyle and Ipsilateral Ulnar Olecranon.

Combined fractures of the lateral condyle of the humerus and the ipsilateral ulnar olecranon are rarely seen in children. Therefore, the mechanism and suitable treatments remain debatable. This study describes the possible mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures and presents the treatment results. Children diagnosed with combined fractures of the humeral lateral condyle and ipsilateralulnar olecranon from July 2010 to July 2020 were retrospectively analyzed. Humeral lateral condyle fractures were treated with open reduction and internal fixation with bioabsorbable pins. Ulnar olecranon fractures were treated with closed reduction and percutaneous pinning with K-wires for Mayo type IA fractures and with tension-band wiring or a locking plate for Mayo type IIA fractures. The postoperative function and appearance of the elbow were evaluated using the Flynn criteria and Mayo Elbow Performance Score (MEPS) at follow-up. The cohort comprised 19 patients aged from 4 to 11 years. Bony compression and avulsion by attached muscles and ligaments may be the leading factors causing the combined injuries, as the children fell with an outstretched and supinated elbow. The average follow-up time was 33 months. High MEPS of >90 indicated that good to excellent results were obtained without complications. This study proposed a reasonable hypothesis for the mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures in children. Satisfactory outcomes were achieved with bioabsorbable pins for lateral condyle fractures and closed reduction and percutaneous pinning with K-wires, tension-band wiring, or locking plate for olecranon fractures.

Prospective review of open reduction and internal fixation with Kirschner wires (K-wires left exposed) fixation in displaced and rotated (Song V) lateral humerus condyle fractures in children

Background: Fractures of the lateral condyle of the humerus account for 10-15% of all elbow fractures in children. These include Salter Harris type 2 and type 4 growth plate injuries in which the fracture crosses the distal humeral growth plate and enter the elbow joint. Open reduction and internal fixation with K wire is treatment of choice for the displaced as well as minimally displaced lateral condyle fractures of children to prevent malunion, nonunion and further displacement. Methods: This was prospective analytical study conducted in Rajendra Institute of Medical Sciences, Ranchi from December 2020 to December 2022 which consisted of 30 patients (of whom only 27 were present for follow ups) who were treated by ORIF with K-wires fixation. We followed the classification pattern given by Song et al. Results were evaluated according to the criteria given by the Hardacre et al. Results: Major culprit for injuries was fall from height (44.4%), followed by playing indoor games (25.9%). RTA and sports each constituted of (14.8%). Functional outcomes based on Hardacre criteria are excellent (85.1%), good in 11.1% cases and fair in 3.7% cases. Conclusions: Our findings demonstrate that open reduction and internal fixation with 2 or 3 K-wires (which were left exposed) and immobilization with casting for 3-4 weeks is sufficient for most of displaced and rotated fractures of the lateral condyle of the humerus.

Morphometric analysis of adult Hippopotamus forelimb bones

Background: Understanding the adaptative changes in bone shapes among animals involves studying bone morphology. We examined adult hippopotamus (Hippopotamus amphibius)forelimb bones at the anatomy laboratory of Patuakhali Science and Technology University, Bangladesh. Samples were collected from Rangpur Recreation Park and Zoo between September 2021 and July 2022. Methods: Bones were processed by removing mud and boiled with water. Subsequently, hydrogen peroxide was used for one and a half hours to remove any remaining muscular tissues from the bones. Following this, the bones were air-dried under sunlight for a month. Measurements of key parameters including length, height, width, circumference, and weight were obtained using calibrated instruments, thereby ensuring precision. Results:The scapula displayed a pronounced and elongated spine – the spina scapulae – that demarcated the lateral surface into two distinct fossae: the supraspinous fossa and the infraspinous fossa. The distal expansion of the spine, known as the acromion process, consisted of the fused hamate process and suprahamate process. The head of humerus was round and featured two undivided tubercles: the greater or major and the lesser tubercle. On the medial surface, a small and shallow radial fossa was observed, while on the opposite side, a large and deep olecranon fossa was present. The proximal surface of the radius head exhibited concave fovea capitis radii, which articulated with the lateral condyle of the humerus. The shaft of the radius was slightly expanded in the cranio-caudal direction. Similarly, the shaft of the ulnahad a somewhat triangular shape, resembling the shape of the radius shaft. Medially, it had a convex facet that articulated with the radius, and cranially, the interosseous space between the radius and ulna was longer than the caudal view. Conclusions: The unique anatomical features and morphometric measurements of the forelimb bones in hippos can be beneficial for identification, radiographic interpretation, and forensic investigation. Furthermore, this study provides essential guidelines and insights for understanding appropriate anatomical parameters.

Anatomical observation and CT three-dimensional reconstruction of Five-shu acupoints of Shaoyin Heart Meridian in rabbit's forelimb

To investigate the location and anatomical structure of "Shaochong"(HT9), "Shaofu"(HT8), "Shenmen"(HT7), "Lingdao"(HT4) and "Shaohai"(HT3) in the rabbit's forelimb. Sixteen rabbits (half male and half female) were used in the present study. By referring to the national standards on the location of acupoints in the human body and the literature about the location of acupoints in the rabbit, and by using the method of comparative anatomy, the location and needling operation of the Five-shu acupoints of Shaoyin Heart Meridian on the rabbit's forelimb were defined, and these acupoints were needled and CT three-dimensional reconstruction were conducted. Then, the rabbits were killed, and intravascular perfusion was performed, followed by inserting acupuncture needles into these five acupoints for observing the anatomical relationship between the inserted acupuncture needle and the structure of surrounding tissues. HT9 is located at the medial side of the little finger of forelimb, about 1 mm beside the nail root, and is adjacent to the superficial flexor tendon of the finger, the dorsal branches of the proper palmar digital artery and vein, and the endings of dorsal branch of palmar digital proper nerve of the ulnar nerve on the fifth finger side. HT8 is located at the palm side of the forelimb, horizontally parallel to the proximal end of the 5th metacarpophalangeal joint and between the 4th and 5th metacarpal bones, and is adjacent to the lumbricalis, the 4th and 5th interossei, and common palmar digital artery and vein and the palmar digital proper nerve of the ulnar nerve. HT7 is located at the medial margin of the extensor carpal tendon on the ulnar side, between the distal end of the ulna and the ulnar carpal bone, and is adjacent to the tendons of flexor carpi ulnaris and extensor carpi ulnaris, ulnar artery, ulnar vein and ulnar nerve. HT4 is located at the medial border of the ulnar flexor tendon, about 1.5 cun superior to HT7, and is adjacent to extensor carpi ulnaris, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, ulnar artery, vein and ulnar nerve. HT3 is located at the depression, medial to the condyle of humerus when the elbow is bent at 90°, its neighbor structure is composed of pronator teres, biceps brachii, brachial artery and vein, radial collateral artery, radial collateral vein, medial antebrachial cutaneous nerve and median nerve. In the rabbit, there is a close relationship between HT9, HT8, HT7, HT4 and HT3 regions and brachial vascular and its branches, cephalic vein and its branches, medial antebrachial cutaneous nerve, median nerve and ulnar nerve, which is the morphological basis of the Five-shu acupoints of Shaoyin Heart Meridian for treating some related clinical disorders.

Trapezoidal Osteotomy for Treatment of Long-Standing Nonunion of Lateral Humeral Condyle Fracture With Cubitus Valgus Deformity

Long-term nonunion of the lateral humerus condyle fracture may lead to progressive cubitus valgus, elbow pain and instability, and secondary ulnar neuritis. A number of techniques of osteotomy are available for correction, but each has its disadvantages. The aim of this study was to present a technique of medial trapezoidal osteotomy for correcting nonunion of the lateral humeral condyle with an elbow valgus deformity >20°. Eight patients (mean age, 7.5 years) with cubitus valgus, after neglected nonunion of a lateral humeral condyle fracture of greater than 2 years duration, were treated with trapezoidal combined osteotomy. The mean interval from the lateral condylar fracture to surgery was 3.1 years. The osteotomy lines were marked on the bone with a template made before surgery. The lateral condyle and osteotomy site were fixed with K-wires, and the elbow joint was immobilized in a plaster brace. Pre- and postoperative carrying angles, range of motion, elbow function, and ulnar nerve neuropathy were analyzed. The mean follow-up was 5.9 years. Union of the lateral condyle was achieved in all patients; 3 healed at 8 weeks, 2 healed at 9 weeks, 2 healed at 10 weeks, and 1 healed at 12 weeks. The mean carrying angle decreased from 30.1° before surgery to 5.8° after surgery. The surgery did not reduce the range of motion at the elbow. According to the Mayo Elbow Performance Score, 6 patients had excellent elbow function, and 2 had good elbow function at the last follow-up. All preoperative ulnar nerve symptoms resolved. One patient had a mild surgical site infection. No other complications occurred. Medial trapezoidal osteotomy appears to be an effective method for treating nonunion of lateral humeral epicondyle fracture with cubitus valgus deformity. Therapeutic V.

УСТРОЙСТВО ДЛЯ ЗАКРЫТОЙ РЕПОЗИЦИИ, ФИКСАЦИИ КОСТНЫХ ФРАГМЕНТОВ И ПОСЛЕДУЮЩЕГО ВЫПОЛНЕНИЯ ПОГРУЖНОГО ОСТЕОСИНТЕЗА У БОЛЬНЫХ С ПЕРЕЛОМАМИ МЫЩЕЛКА ПЛЕЧЕВОЙ КОСТИ

Background. Intra-articular fractures of the distal humerus are complex injuries that can subsequently significantly limit the function of the elbow joint. Transosseous osteosynthesis has a number of undeniable advantages: low trauma, accurate reposition of bone fragments using closed methods, stable fixation of bones, early movements in the injured joint both with and without hinges. However, this method of surgical treatment is not without a number of complications. Objective. Develop and test a device for closed reposition, fixation of bone fragments in patients with fractures of the distal humerus and subsequent ORIF. A device has been develop for closed reposition, temporary fixation of bone fragments in patients with fractures of the humerus condyle and subsequent ORIF. In 24 patients with intra-articular fractures of the distal humerus (according to the AO classification: 13 - C2 - C3), internal fixation was performed. In patients of the first group (comparison group, 14 cases), one-stage open osteosynthesis with submersible fixators was performed within 4–14 days after injury. In patients of the second group (main group, 10 cases), a two-stage treatment of fractures of the condyle of the humerus was carried out using the developed device. Results. All patients of the main group achieved good results of treatment: no complications were detected; the timing of fracture consolidation did not differ from the average.

Safe Arthroscopic Approaches for Epicodilitis: Topographic-Anatomical Study

Background. Arthroscopic methods of diagnosis and treatment of elbow diseases have not yet become widespread due to the small volume of the joint, the close location to neurovascular bundles and the manipulation difficulty.
 The aim of the study was to determine the safe zones for the minimally invasive approaches to the elbow in patients with lateral and medial epicondylitis.
 Methods. A complex anatomical and clinical study was performed. The anatomical part was carried out on 30 non-fixed anatomical preparations of the upper limb. The features of the tendon-muscular and neurovascular structures surrounding the elbow were studied, depending on the angle of elbow flexion at three different levels: level I 5 cm above the articular gap, level II the articular gap, level III the neck of the radius. In the clinical part of the study, the these structures were studied by MRI in 30 patients.
 Results. The brachial artery at the level I is located from the bone at a distance 28.6 (28.4-28.7) mm at the elbow flexion to 90. The radial nerve at level II is located at a distance of 15.8 (15.6-16.0) mm from the nominal medial epicondylar line (NMEL). From the NMEL the median nerve is located at a distance of 17.5 (16.6-18.1) mm, the brachial artery 22.4 (20.5-22.8) mm. The anterior bundle of the medial collateral ligament has the following average width throughout: the proximal part 6.21.4 mm; the middle part 6.51.5 mm; the distal part 9.31.4 mm. The average area of the medial collateral ligament attachment to the medial condyle of the humerus was 45.59.3 mm2 and has a rounded shape. The average length of the radial collateral ligament was 20.51.9 mm; width 5.20.8 mm, the average area of its attachment to the humerus was 13.61.4 mm2. The average area of the extensor carpi radialis brevis on the lateral condyle of the humerus was 53.13.7 mm2. The average distance from the entrance of the deep branch of the radial nerve into the supinator canal to the articular gap 28 (25.5-29.6) mm.
 Conclusion. The results of the study make it possible to choose the safe arthroscopic approaches to the elbow with minimal risk of damage to neurovascular structures in the treatment of patients with lateral and medial epicondylitis.

Role of Percutaneous Screw Fixation in Children with Delayed Presentation and Nonunion of Lateral Condyle Humerus Fractures with Elbow Stiffness.

Delayed presentations and nonunion of lateral condyle of Humerus (LCH) fractures in children are common. It is recommended to gain elbow movements before placing single screw for late presenting LCH fractures. We examined the efficacy of a percutaneously placed screw in delayed presenting LCH fractures and LCH nonunion in children who presented with varying degree of elbow stiffness without waiting for improvement in elbow movements. Sixteen children with LCH fractures presenting after six weeks of fracture, without signs of union, and with frank nonunion were treated with percutaneous placement of the cancellous screw. There was a delay of 1.5 to18 months before presenting to us. The results were assessed by Dhillon criteria. All the patients at presentation had flexion deformity (avg 290) and restricted flexion ((avg 1000). Successful radiological union was achieved in fifteen patients. All the patients had full recovery of extension. Fifteen patient regained full flexion and one patient has only 100 flexion restriction (p value < 0.001). At the final follow-up, fifteen patients had excellent and one had a good overall Dhillon score. There was no clinically evident varus or valgus deformity. We could achieve union in a majority of the patients with delayed presentation and established nonunion of LCH fractures with simple percutaneous screw placement, thereby avoiding open surgery, big scar, bone grafting, and AVN of LCH. We did not wait for an improvement in elbow movements before screw fixation and still all our patients regained full elbow movements with improved Dhillon scores.

Gorham Disease of Distal Humerus Successfully Treated by Slight Shortening and Pin and Plate Fixation

Background: Gorham's disease (GD) is one of the scarce and idiopathic skeletal diseases which causes osteolysis following the proliferation of blood vessels. Progressive osteolysis GD of distal humerus with articular involvement and pathologic fracture has not been reported and our case is the first report of this disease involving distal humerus and its joints’ surfaces.&#x0D; Case Report: A 9-year-old boy, case of nonunion of medial condyle of humerus and pathologic fracture of distal humerus after minor trauma, was referred to our clinic and treatment started by casting but due to displacement and nonunion, we decide to operate him. Intraoperative finding was in favour of aneurysmal bone cyst (ABC) near fracture site; therefore, wide resection and fixation by medial tension band wiring (TBW), lateral plating, and fibular allograft application was done (post-operation pathologic result did not show microscopical features of this tumor) and 6 weeks later, he developed stress riser fracture above lateral plate; thus, plate removal was done and severe bone resorption was revealed. Therefore, another specimen was sent for pathology that showed hamartomatous and hemangiomatous lesion of bone. All findings were in favour of GD. He was operated another time and fixed by Persian fixation with small pins and plate, and early plate removal was done for prevention of stress riser fracture.&#x0D; Conclusion: In cases of GD of distal humerus and pathologic fracture, Persian fixation is a good option for fixation and we suggest early device removal for prevention of stress riser fracture.

Fractures of the condyle head of the humerus in children and their treatment

The study included 64 children with fractures of the head of the condyle of the humerus. Three groups of patients were identified depending on the ratio of the shoulder condyle head to the radial head. Treatment methods are clearly described for each group. Long-term results tracked in 41 patients indicate the correct choice of treatment methods: the vast majority of children received good and satisfactory results.

Nonunion of the Lateral Condyle of Humerus

Lateral condyle humerus fracture in children is known to have union complications. Delay in diagnosis, pull at the common extensor origin, precarious blood supply and lack of appropriate treatment may result in non-union. Non-union of lateral condyle can lead to progressive cubitus valgus. Progressive cubitus valgus may be associated with pain, instability and stiffness of the elbow and ulnar nerve paresis. Plain radiographs of the elbow are required for the assessment of the joint congruity, size of the lateral condyle fragment, extent of the elbow deformity and physis status. Corrective osteotomy with anterior transposition of the ulnar nerve gives good cosmetic and functional results.

Differentiated approach in the treatment of fractures of the distal humerus in children based on the use of bioabsorbable implants

In the practice of pediatric traumatologists there are a number of complex problems in the treatment of fractures of the distal humerus, which require a differentiated approach: atraumatic anatomical reposition with minimal damage to active growth zones, minimal damage to articular cartilage during surgery, stable fixation and early rehabilitation. At present, the generally accepted methods of osteosynthesis (fixation with K - wires, metal screws, etc.) do not fully meet the requirements of modern pediatric traumatology. One of the newest methods of fixation in the treatment of fractures of this localization, which have significant advantages is the use of bioabsorbable implants (BAI). Purpose - to present a differential approach to the treatment of distal fractures of the humerus in children based on the use of bioabsorbable implants. Materials and methods. During the period from 2015 to 2021, 15 children aged 5 to 17 were treated at the Chernihiv Regional Children’s Hospital. Distribution by type of pathology: epiphyseal fracture of the humeral condyle head - 5, osteoepiphyseolysis of the lateral humerus condyle - 2, fracture of the medial epicondyle of the humerus - 8 cases. Damage to nerve and vascular structures was never diagnosed in this group of patients. At the preoperative stage, radiography of the elbow joint in standard projections for such injuries was used to diagnose the above injuries. In the course of surgery, bioabsorbable cannulated screws and Bioretec pins were used to fix the repositioned fragments. Results. In the process of surgery, standard approaches and repositioning techniques were used, according to the anatomical features of each fracture. The differentiated approach was to use cannulated screws in the case of osteosynthesis of extra-articular fractures (osteoepiphyseolysis of the medial epicondyle of the humerus) in older children (12 to 17 years), which allowed to create dosed compression of fragments and bioabsorbable perfect anatomical reposition. In 1 case there was a combined osteosynthesis: fixation of the metaphyseal fragment with a K - wires and synthesis of the intra-articular epiphyseal fragment with a bioabsorbent pin. Advantages of BAI: minimal damage to articular cartilage, preservation of congruence and anatomical shape of the articular surface at the site of implant placement (Pin), stable fixation and interfragmentary compression (autocompression property), intraoperatively received full range of motion in the joint. All patients received full consolidation in time according to the age of the injured child. The range of motion and function of the limb is completely restored. The children did not need repeated surgery. Conclusions. 1. The advantages of using bioabsorbable implants in cases of treatment of fractures of the distal humerus in children are demonstrated. 2. The use of BAI allows to minimize damage to the growth zones and joint surface during osteosynthesis, provides stable fixation and interfragmentary compression, creates conditions for optimal fracture fusion and further rehabilitation. 3. Due to the properties of bioabsorption there is no need to remove the implant, ie re-trauma to the structures of the elbow joint of the growing organism, no need for re-hospitalization, anesthesia and surgery, re-rehabilitation, reduces the likelihood of psychological trauma in children. 4. As a result, all of the above improves the anatomical and functional results of treatment of these injuries, saves financial costs of both the medical institution and the state, and reduces the stress on family budgets. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children, bioabsorbable implants, fractures of the distal humerus, trauma in children, growth zones, osteosynthesis.

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.

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.

Entrapment of the Brachial Artery Following Supracondylar Fracture Reduction: A Case Report

Background: Supracondylar fractures of the humerus are common elbow fractures in children. Supracondylar fractures have two subtypes: flexion, which makes up less than 2% of all such fractures, and extension, which makes up more than 98% of supracondylar fracture of the humerus. Supracondylar fractures of the humerus can develop vascular and neurological complications, either following the fracture itself due to the detached pieces of bone or after reduction or K-wire fixation therapy. The most common complication is damage to the brachial artery. Case Presentation: Our patient is a healthy 7-year-old right dominant boy who sustained a Gartland type III fracture following a fall and was admitted to the Emergency Ward. At first, a weak pulse was detected in the distal part of the right upper extremity. After the reduction using 2 K-wires, the distal pulse of the limb became undetectable. Vascular examination revealed that the adventitia of the brachial artery was trapped between the condyle parts. The artery was then released, and the distal pulse returned. Conclusions: This case shows that although entrapment and pulling of the adventitia of the brachial artery between the condyles of the humerus following a supracondylar fracture is a rare occurrence, it can happen in this type of fracture. After reduction using K-wires percutaneously, a neurovascular examination in all cases of supracondylar fractures is necessary. In supracondylar fractures with pink pulseless limbs, immediate arterial exploration can achieve a markedly better outcome than simply monitoring.

Hypermobility of ulnar nerve does not affect throwing performance (122)

Objectives:Ulnar nerve neuropathy around the elbow is a common pathology in throwing athletes, and occurs due to many factors including valgus elbow, and ulnar nerve hypermobility. For patients with ulnar nerve neuropathy, anterior transposition of the ulnar nerve is common procedures. Meanwhile, Ulnar nerve hypermobility has been reported to be present in 2% to 47% of asymptomatic individuals. However, no studies have investigated the rate of ulnar nerve hypermobility in throwing athletes, and the relationship between ulnar nerve mobility, and clinical symptom and throwing performance. This study was designed to classify the sonographic assessment for the mobility of the ulnar nerve compared to physical evaluation, and to determine whether ulnar nerve hypermobility is associated with clinical symptoms and throwing performance in baseball players. We investigated ulnar nerve hypermobility using ultrasound to evaluate the relationship between the ulnar nerve hypermobility and clinical sign including throwing performance in college baseball players.Methods:138 elbows in 69 college baseball players were examined. Each participant was queried regarding symptoms attributable to the ulnar nerve. In addition, structural measurements consisting of the tinel test and elbow flexion compression testing were examined. Sonographic examiners were, unaware of reported symptoms, independently performed a standardized examination of both elbows to assess ulnar nerve hypermobility. For sonographic assessment, the ultrasound probe was located at the medial condyle of the humerus to visualize the ulnar nerve in short-axis view in the extended elbow position. During extension to flexion of the elbow, the mobility of ulnar nerves was assessed, and categorized as stable, or hypermobile, which was further subclassified as subluxation, or dislocation (Figure 1A, 1B, 1C). Pared t-test was used to compare the mobility of the ulnar nerve between throwing and non-throwing sides. Fisher’s exact test was used to assess the relationship between physical exams and the mobility of the ulnar nerve. Values of p<0.05 were considered statistically significant.Results:Ulnar nerve hypermobility was identified in 54 (78.3%) of the 69 elbows in throwing side. Meanwhile, hypermobility was 53 (76.8%) in non-throwing side without significant difference, compared to non-throwing side. Elbows with nerve hypermobility did not experience a higher prevalence of subjective symptoms (snapping, pain, and tingling) than did elbows with stable nerves. Provocative physical examination testing for ulnar nerve irritability, however, showed consistent trends toward heightened irritability in hypermobile nerves (p = 0.04 to 0.16). Demographic data and anatomic measurements were similar between the subjects with stable nerves and those with hypermobile nerves. Additionally, all participants did not show decrease of throwing performance.Conclusions:Ulnar nerve hypermobility occurs in over half of the baseball players in throwing and non-throwing sides. Utilizing a standardized sonographic examination, a diagnosis of ulnar nerve hypermobility can be established with substantial interobserver reliability. In baseball players, ulnar nerve hypermobility does not appear to be associated with an increased symptomatology attributable to the ulnar nerve and throwing performance. Anterior transplantation of ulnar nerve may not be needed for baseball players with ulnar nerve neuropathy.

Image Fusion of X-ray and Magnetic Resonance Imaging-Based Evaluation of the Stability of Pediatric Lateral Humeral Condyle Fracture

Background: Lateral humeral condyle fracture is the second most common intra-articular fracture in pediatric elbow. Objectives: The present study aimed to analyze the differences between X-ray and magnetic resonance imaging (MRI) in the evaluation of the stability of pediatric lateral humeral condyle fracture and the degree of fracture displacement. Methods: A total of 78 patients with acute elbow trauma were selected and hospitalized in our orthopedic department from July 2018-July 2019. All patients were examined with X-ray and MRI. The sensitivity and specificity of X-ray and MRI in the diagnosis of lateral humeral condyle fracture and the integrity of the trochlear cartilage chain fracture were calculated. The X-ray and MRI were examined respectively to check the value of lateral and posterior fracture space of lateral humeral condyle fracture. Results: Callus repair was observed according to the observation of fracture line during operation or the follow-up imaging examination of conservative treatment. It was confirmed that out of 78 patients with elbow joint trauma, 72 cases were diagnosed with the fracture of lateral condyle of humerus, and the other 6 patients were cured without fracture signs. The sensitivity of MRI in the diagnosis of pediatric lateral condylar fracture was 100%, which was significantly higher than that of X-ray (88.89%) (P&lt;0.05). The results of X-ray and MRI in the diagnosis of pediatric lateral condylar fracture were generally consistent (kappa value = 0.465;&lt; 0.01). Among the 72 confirmed cases, 35 subjects had a fracture of trochlear cartilage chain. The sensitivity of MRI in the diagnosis of pediatric fracture of lateral condyle of humerus was 97.14%, which was significantly higher than that of X-ray (62.86%) (P&lt;0.05). The difference was statistically significant (P&lt;0.05). The sensitivity of 3d-fs-fspgr or 3d-fspgr was significantly higher than that of fs-t2wi and fs-pdwi (P&lt; 0.05). Conclusion: As evidenced by the obtained results, MRI was superior to X-ray in the diagnosis of pediatric humeral epicondylar fracture stability and evaluation of fracture displacement. Furthermore, 3d-fs-fspgr or 3d-fspgr was the best MR sequence to show the pediatric humeral epicondylar fracture. These findings can provide theoretical basis for the establishment of clinical treatment plan.