Condyle Of Humerus Research Articles

Exposed versus buried wires for fixation of lateral humeral condyle fractures in children: A comparison of safety and efficacy

Displaced fractures of the lateral condyle of the humerus are usually treated with open reduction and fixation with smooth Kirschner wires. These may be passed through the skin and left exposed or buried subcutaneously. Exposed wires may be removed in the outpatient clinic, whereas buried wires require a formal procedure under anaesthesia. This advantage may be offset if there is a higher rate of complications with exposed wires. The aim of this study was to compare the safety and efficacy of exposed and buried wires. Retrospective cohort. Children with lateral condyle fractures of the humerus who had undergone surgery were identified from our departmental database. Case records and X-rays of 75 patients were reviewed. Forty-two patients had buried wires and 33 had exposed wires. There were no serious complications in either group. In the exposed wires group, 1 patient had a superficial wound infection that was treated effectively with 1week of oral antibiotics, while 2 patients had hypergranulation of pin tracts treated with topical silver nitrate. None of the patients showed loss of reduction, deep infection, or any other complications requiring additional procedures. There was no statistically significant difference in the rate of complications between the buried and exposed groups. We conclude that open reduction and exposed wiring is a safe and effective option for lateral condyle fractures, and recommend a period of 4weeks of K-wire fixation followed by 2weeks of backslab immobilisation as adequate for union with minimal risk of infection.

OPEN REDUCTION AND K-WIRE FIXATION OF DISPLACED UNSTABLE LATERAL CONDYLE FRACTURES OF THE HUMERUS IN CHILDREN

Background: Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. Objective: To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Design: Prospective. Setting: Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. Period: From January 2008 to December 2010. Method: In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Results: Excellent to good results were observed in all the12 patients presenting at 1–4 weeks post injury. In 5 patients presenting at 5–8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Conclusions: Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate.

Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child

For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.

Office device to aid in Implanon insertion

Implanon remains as an important component of the available means of hormonal contraception. This rod, implanted subdermally, has the highest rate of effectiveness of available contraceptive methods. It is recommended that the Implanon be placed in the nondominant arm, approximately 6 cm from the inner condyle of the humerus and in between the biceps and triceps muscles. These are the only specific directions for locating the insertion of the implant [ [1] Implanon package insert ��� Organon. Google Scholar ].

Distal humerus lateral condyle fracture in children: When is the conservative treatment a valid option?

Distal humerus condyle fracture in children is rare. These fractures often mislead the emergency physician or surgeon. However, treatment adapted to the degree of displacement achieves excellent clinical and radiographic results. The objective of this study was to clarify indications for conservative treatment of lateral humeral condyle fracture in children. Twenty-two children who had sustained lateral humeral condyle fracture between January 2007 and January 2010 were reviewed in April 2010. At this consultation, the children underwent clinical and radiological examination. The Hardacre functional score was used to determine objective clinical outcome. Conservative treatment was exclusive to cases of lateral condyle displacement equal to or less than 1mm. All other fractures were managed by surgical open reduction and fixation using cross-pinning. There was no statistically significant difference in clinical or radiological outcome between conservative and surgical management. Lateral humeral condyle fracture is difficult to diagnose in children. The majority of poor results reported in literature relate to inadequate initial treatment. Given a radiological aspect of hemarthrosis of the elbow, the emergency physician prescribes multiple X-ray views of the affected elbow (anteroposterior, lateral and internal oblique). The clinical aspect of lateral humeral condyle fracture is often characteristic (ecchymosis facing the head of the radius). Nondisplaced or minimally displaced lateral humeral condyle fracture can be managed conservatively under close survey. However, secondary displacement under the cast is often difficult or impossible to detect, and outpatient surgery is therefore being increasingly indicated in our department.

Late presentation of fractures of the lateral condyle of the humerus in children

Background:The current controversy regarding the management of fractures of the lateral condyle of the humerus presenting between 3 to 12 weeks prompted us to evaluate our results of open reduction and internal fixation of such fractures.Patients and Methods:Twenty-one patients operated between March 1995 and February 2001 qualified for this study. Five patients presented between 3–4 weeks, nine between 5–8 weeks and seven between 9–12 weeks post injury. Ten fractures were classified as stage II and eleven as stage III (Jacob et al. criteria). The mean age was 8 years (range: 4–14 years). All patients underwent surgery (open reduction and internal fixation with K-wires/screw, with or without bone grafting). The results were assessed by the modified criteria of Agarwal et al. after an average follow-up of 2.3 years.Results:Excellent to good results were observed in all the five patients presenting at 3–4 weeks post injury. In the patients presenting at 5–8 weeks, the results were excellent in one, good in four, fair in three, and poor in one patient. The fracture united in all cases; however, malunion was observed in four patients. The fractures that were operated at 9–12 weeks showed good results in one case, fair result in three cases, and poor result in three cases. Avascular necrosis of the lateral condyle in one patient, premature fusion in two patients, pin tract infection in three patients, and gross restriction of elbow movements in three patients were the major complications in this group. Accurate reduction was difficult as a result of new bone formation and remodeling at the fracture surfaces. Multiple incisions over the common extensor aponeurosis and bone graft supplementation were helpful for achieving acceptable reduction.Conclusion:Open reduction and internal fixation is recommended in all cases of displaced fractures of the lateral condyle of the humerus presenting at up to 12 weeks post injury. However, the results become poorer with increase in duration after injury and the grade of displacement. To avoid complications it is important to carry out careful dissection of the soft tissue attachments and to mobilize the fragment without the use of force.

The Treatment of Upper Limb Fractures in Children and Adolescents

The treatment of fractures in children and adolescents must be based on an adequate knowledge of the physiology of the growing skeleton. Treatment failures usually do not result from technical deficiencies, but rather from a misunderstanding of the special considerations applying to the treatment of fractures in this age group. We selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development. Alleviating pain is the first step in fracture management, and due attention must be paid to any evidence of child abuse. The goals of treatment are to bring about healing of the fracture and to preserve the function of the wounded limb. The growth that has yet to take place over the remaining period of skeletal development also has to be considered. Predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. During the period of skeletal development, conservative and surgical treatments are used in complementary fashion. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents. The main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment (either in the hospital or on an outpatient basis) to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.

Experts' agreement on therapy for bone metastases

Experts' agreement on therapy for bone metastases

Closed Reduction and Internal Fixation of Completely Displaced and Rotated Lateral Condyle Fractures of the Humerus in Children

To determine the usefulness of closed reduction and internal fixation as the initial treatment for completely displaced and rotated fractures of the lateral condyle of the humerus in children. Prospective. Three Level I trauma centers. We prospectively studied 24 consecutive completely displaced and rotated lateral condylar fractures of the humerus in children (Jakob Stage 3, 20 boys and four girls) that were treated by three different surgeons working at different hospitals during the same period. In 21 fractures, we initially attempted closed reduction and internal fixation; in three, we used open reduction and internal fixation and made no attempt at closed reduction. We assessed the preoperative degree of displacement and postoperative radiographic quality of closed reduction. Clinical results were graded using the criteria suggested by Hardacre et al. Eighteen of 24 (75%) completely displaced and rotated fractures were reduced within 2 mm of residual displacement using the closed method. Three fractures were treated with open reduction and internal fixation initially and internal fixation because of one surgeon's lack of confidence in closed reduction, because of lack of experience with it, early in the study period. Closed reduction to within 2 mm failed in three fractures, so open reduction and internal fixation was then performed. There were no significant complications such as limited range of motion, pain, osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest. Closed reduction and internal fixation is an effective treatment for completely displaced and rotated lateral condyle fractures of the humerus in many children.

Treatment of the"C"fracture of humerus condlye with locked compressive steel plate

Objective To evaluate the clinical value and feasibilitv of locked compressive steel plate in treatingCfracture of humerus condyle.Methods From feb 2007 to Oct 2009,12 cases suffering fromCfracture of humerus condyle treated by interal fixation with LCP were chosen.The cases received median incision along outer margin of elbow by olecranon joint extra-approach of osteotomy and were fixed with locked compressive steel plate.Some fractures were repaired with bone grafts.Results All of the cases were followed up for 8.7 months(3～15 months on average).The rate of good was 83.3%according the grade ofcassebaum.Conclusions Treated with olecranon process of ioint osteotomy along ertra-approach and open reduction with interal LCP fixation,theCfracture of humerus condlye can achieve firming fixation and improved elbow joint functional recovery with advantages of simplifed operative maneurevr and reduced tissue damage. Key words: LCP; Extra-articular olecranon osteotomy; Cfracture of humerus condlye

Surgical Treatment With Nonunion Of The Lateral Humeral Condyle Of Humerus With Cubitus Valgus In Children Using Apparat Ilizarov

Background. Nonunion of the lateral humeral condyle are of the complex pathology of the elbow joint, occurring relatively often and resulting in disability of children.The treatment of nonunion of the lateral humeral condyle of humerus with cubitus valgus remains controversial. Purpose of this report was improvement of the results of surgical treatment of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus with use of differential approach to the surgical strategy.Material and methods. We were observing 28 children (17 boys and 11 girls) with nonunion and long-standing nonunion of lateral condyle of humerus, with various degrees of severity. There were used MRI and X-ray investigations for differential study of the patients divided into 3 groups in relation to stability and non-stability of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus.Results. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarov’s technique. The mean postoperative humerus-ulna angle was 6,0 degrees of cubitus valgus. All of reverse T-osteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of follow-up was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarov’s technique. The mean postoperative humerus-ulna angle was 6,0 degrees of cubitus valgus. All of reverse T-osteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of follow-up was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients.

Papers Survey of cull sow bone and joint integrity in the Moorepark Research Farm herd

The objective of this study was to examine the effects of production (the number and weight of pigs produced over a lifetime) on the physical and mechanical properties of the...

Osteosynthesis for Nonunion of the Lateral Condyle of the Humerus

Purpose: Although nonunion of the lateral humeral condyle is a rare complication in children, it can result in a number of complications, and treatment is controversial. Our study shows the results of using osteosynthesis in patients whose lateral humeral condyle was not united. Materials and Methods: We studies 16 patients (M : F=13 : 3; Age: years) who were diagnosed with nonunion of the lateral humeral condyle and who underwent osteosynthesis. The mean period of nonunion was 56.2 months (5-132 months). Outcome measures were range of movement, bone union, functional score, and carrying angle and were assessed both before and after surgery. Results: Bones of all patients were united within 3 months of the operation; there were no complications. After surgery, a decreased range of movement was observed for 3 of 16 patients. However, the functional index for all patients was improved. In other words, the range of movement could be reduced while the functional index was improved so that the deformity would be lessened. Conclusion: Osteosynthesis was successful in repairing the nonunion of the humeral lateral condyle. Therefore, osteosynthesis is suggested for patients who have had no treatment for nonunion of lateral humeral condyle for a long time.

Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults

This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male (20 patients) and female (6 patients) of different age group treated with open reduction and internal fixation with 4.5 mm malleolar screw or 6.5 cancellous screw and reconstructed condyles of the humerus were fixed to the diaphysis with either dual reconstruction plates or one third tubular plates or small fragment DCPs preferably via trans-olecranon approach. Immediate post operative mobilization was started as patient was pain free. Most of the patients (50%) were between age group of 21-40 years. Mode of injury in 18 (70%) cases was road traffic accident and rest cases were due to fall from height. 20 cases (77%) belong to AO/ASIF classification C1 and14 case (54%) belong to Riseborough and Radin’s classification type III. 22 (85%) of 26 cases showed timely union at 18 weeks. Pain and stiffness in 3 (11.5%) patients, implant loosening in 3 (11.5%) patients were the common complications of this study. In our study 13 (50%) patients had range of motion (ROM) between 100 and 120 degrees. Based on Jupitar et al system 20 patients (77%) had ‘Excellent’ to ‘Good’ results and 6 patients (23%) had fair to poor results. INTRODUCTION Intercondylar fractures of the distal humerus are relatively rare and difficult to manage. Since the original description by Desault in 1811, the intercondylar fracture of distal humerus remained one of the most difficult of all the fractures to manage. Although it is a less common fracture, but in the past few years the incidence is increasing due to modernization and increased road traffic accidents. MECHANISM OF INJURY Wilson and Cochrane (1928), described mechanism of injury. They suggested that the separation of condyles in this type of fracture may be created by the splitting effect of humeral shaft as it is forced distally. The injury can occur either in flexion or extension of elbow. The fracture is probably caused by the impact of olecranon in the trochlear groove thereby diverging the condyles of distal humerus apart. MATERIAL AND METHODS This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male and female of different age group treated in the Department of Orthopaedics, Government Medical College Jammu. Once the General Condition stabilized, patients were sent for Xrays and fracture was classified according to AO/ASIF as well as Riseborough and Radins’s classifications. However compound fractures were thoroughly irrigated with Normal saline, antiseptic dressing done, limb splinted and then sent for x-rays. OPERATIVE TECHNIQUE ANAESTHESIA AND POSITION General anaesthesia was given and then patient was turned in either lateral or prone position with elbow flexed at 90 and supported on one side of the table. Tourniquet was applied; whole of upper limb was painted with iodine solution and draped with sterile sheets. Tourniquet was inflated and time noted. APPROACH About 20 cm long incision was given extending about 10 cm proximal and 10 cm distal to the elbow joint on the posterior aspect. Subcutaneous tissue and fascia was incised in the line of skin incision. Ulnar nerve is identified first and is retracted medially with a finger of gloves. Fracture site was exposed either through a trans-olecranon approach or campbell’s posterior approach. Assembling of fragments of distal humerus: (1)Reduction and fixation of condyles: Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults 2 of 6 Both the condyles were reduced and held together with the help of bone holding clamps. Condyles are temporarily fixed with K-wires and then with 4.5 mm malleolar screw or 6.5 mm cancellous screws of adequate length. K-wire is now removed and stability as well as congruity of joint surface was assessed. ii) Reduction and fixation of condyles to metaphysis After the reduction of condyles to the humerus metaphysis, fixation is done with either single or dual (contoured) reconstruction plates or one third tubular plates or sometimes small fragment DCP and cortical screws. K-wires, malleolar screws or cancellous screws can be used in addition. When transolecranon approach was used, the osteomised olecranon was re-fixed with Tension Band wire.

Type 4 capitellum fractures: Diagnosis and treatment strategies

Background:Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee) with gadgets available in a district hospital.Materials and Methods:Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2) and 2.7 mm AO screws (n=1), under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration.Results:All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN.Conclusion:Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher's lateral approach has given good results.

Closed Reduction and Internal Fixation of Displaced Unstable Lateral Condylar Fractures of the Humerus in Children

Open reduction and internal fixation of a displaced unstable fracture of the lateral condyle of the humerus in a child usually produces a good result. Only a few reports have focused on closed reduction and internal fixation of these fractures. We prospectively studied closed reduction and internal fixation to determine its usefulness as the initial treatment for displaced unstable fractures of the lateral condyle of the humerus. We classified lateral condylar humeral fractures into five groups according to the degree of displacement and the fracture pattern as determined on four radiographic views and created an algorithm for the treatment of these fractures on the basis of this classification system. We prospectively treated sixty-three unstable fractures (in forty-two boys and twenty-one girls) and assessed the quality of closed reduction. Thirteen of seventeen stage-3 fractures were reduced to < or =1 mm of residual displacement. Thirty of forty stage-4 fractures and three of six stage-5 fractures were reduced to < or =2 mm of displacement. In ten of forty stage-4 fractures and three of six stage-5 fractures, closed reduction to within 2 mm failed and open reduction and internal fixation was performed. There were no major complications such as osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest. Closed reduction and internal fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in many children. If fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.

Supracondylar and condylar fracture of the humerus

Fractures of the distal humerus around the elbow joint are most often in supracondylar or condylar lesion. This article described the diagnosis, classification, treatment, progress, side-effect, after-treatment and rehabilitation of fractures of supracondylar, lateral condyle and medial epicondyle of the humerus in child, and also described these of supracondylar, epicondylar fractures of the humerus in adult. Physical therapy should include active and active-assisted exercises for joint mobilization as soon as soft tissue healing permits. To prevent the contracture and the loss of motion of the elbow, rehabilitation of the patient and upper extremity should begin immediately, depending on the fracture and soft tissue stability in these fractures.

Transverse Divergent Dislocation of the Elbow With Ipsilateral Distal Radius Fracture in a Child

We report a rare case of an irreducible transverse divergent dislocation of the elbow with an ipsilateral distal radius torus fracture and a fracture of the coronoid process in a 9-year-old male. Closed reduction of the elbow was attempted, but the humeroulnar joint remained dislocated. At surgery, the avulsed anterior band of the medial collateral ligament complex of the elbow was found to be interposed between the medial condyle of the humerus and the olecranon. The dislocation was reduced after relieving the ligament entrapment, which was then repaired. The unstable proximal radioulnar joint was fixed with a Kirschner wire. Two years after surgery, the patient had a painless left elbow with full range of motion and no instability. He was able to use his upper extremity for all activities in his daily life and had returned to sports. No radiographic abnormalities were found at this follow-up, particularly premature epiphyseal closure of the radial head. Closed reduction has been successful in a majority of reported cases of transverse divergent dislocation of the elbow, yet the presence of an incomplete reduction of the ulnohumeral joint should alert the physician to the possible interposition of soft tissues or bony fragments necessitating an open reduction.

Fractures of the Lateral Condyle of the Humerus

Fractures of the Lateral Condyle of the Humerus

Fractures of the external condyle of the humerus in children.

Journal Article Fractures of the external condyle of the humerus in children Get access J N Wilson J N Wilson Cardiff Royal Infirmary, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 43, Issue 177, July 1955, Pages 88–94, https://doi.org/10.1002/bjs.18004317714 Published: 06 December 2005