Condyle In Children Research Articles

Surgical treatment of nonunion of the lateral humeral condyle in children using combined methods of bone grafting and the Ilizarov fixation

Introduction Elbow trauma is common accounting for 40-50 % of all musculoskeletal injuries in children. From them, lateral condyle fractures are the second most common fractures in the pediatric elbow with complications ranging from 3.3 to 54.8 %.The objective was to determine the effectiveness of nonunion of the lateral humeral condyle (LHC) treated with bone grafts harvested from the patient's fibular shaft and the Ilizarov apparatus.Material and methods We report surgical treatment of bone defect repaired with bone graft and the Ilizarov apparatus in 57 children with nonunion of the LHC. Maintained articulation between the non-united bone and the radial head, magnitude and direction of displacement, visible resorption of the epimetaphysis, bone deficiency, malaligned upper limb, late ulnar neuritis were the parameters used for outcome assessment. Depending on the type of surgical treatment the patients were divided into 3 groups: Group 1 (n = 13) included patients who underwent open osteosynthesis and bone fixation using 2-3 Kirschner wires; Group 2 (n = 30) consisted of patients who underwent surgery to repair the bone defect between the humerus metaphysis and an non-united fragment of the LHC fixed with wires and immobilized with a cast; Group 3 (n = 12) included patients who were treated with bone graft followed by fixation of the bone and the graft using Ilizarov wires and frame. Two patients underwent supracondylar osteotomy.Results The outcomes were evaluated based on criteria to include non-union consolidation, joint function, limb alignment and condition of the growth plate. Long-term results were explored in 49 (85.9 %) patients out of 57 over a period of 6 months to 10 years. The results were rates as good in 39 (79.6 %) patients, as fair in 9 (18.36 %) and poor in one (2.04 %) case.Discussion Various types of operations are reported for non-united fractures and non-unions of the cervical spine to include surgeries from open osteosynthesis to complicated reconstructions.Conclusion Surgeries aimed at repair of bone defects using fibular autograft facilitated consolidation of non-unions and engraftments.

Carta resposta referente ao artigo “Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children”

Carta resposta referente ao artigo “Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children”

Prospects for the use of platelet-rich plasma in the complex treatment of stage II–III osteochondritis dissecans of femoral condyles in children: A preliminary report

BACKGROUND:Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation ofanosteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology.
 AIM:To evaluate the efficacy of treatment inasmall clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area.
 MATERIALS AND METHODS:Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was10 (611)months, withamaximum duration of 12 months.
 RESULTS:The observation results demonstrateahigh efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans.
 CONCLUSIONS:The use of orthobiological technologies isanactively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.

A novel approach for the treatment of Jacob II and III fractures of the lateral humeral condyle in children: Percutaneous Kirschner wire fixation with ultrasound localization.

This research investigated the effectiveness of percutaneous Kirschner wire fixation in children with Jacob II and III lateral humeral condyle fractures. 28 children with Jacob II and III lateral humeral condyle fractures were treated with percutaneous Kirschner wire fixation under ultrasound localization, followed by cast immobilization for 4-5 weeks at our institution from January 2018 to April 2022. X-rays were evaluated on the first postoperative day to assess fracture reduction and Kirschner wire fixation. After 2 and 4 weeks, x-rays were taken to assess fracture healing and the presence of discomfort and infection was evaluated. After confirming fracture healing and callus formation, the cast and Kirschner wire were removed. Rehabilitation exercises were conducted following removal to restore elbow function. At the last follow-up, most results were excellent (n = 25) and good (n = 3) according to Flynn's criteria. Moreover, according to the Mayo Elbow Functional Score Scale (MEPS), all 28 children had excellent scores, with no significant difference in MEPS scores between the lesion and healthy sides (t = 1.533, p > 0.05). The present study substantiated that our novel approach is more convenient and effective, brings less trauma and complications and no radiation and deserves clinical promotion.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study.

Background/AimsPaediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period.MethodsThe following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.ResultsBetween 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001).ConclusionThe main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.

Fracture of medial humeral condyle in children: A case report

Fracture of medial humeral condyle in children: A case report

Concomitant Posteromedial Elbow Dislocation with Lateral Condyle Humerus Fracture in a 7 Years Old – A Rare Case Report and Review of the Literature

Introduction:Traumatic dislocations of the elbow are a rare injury in children. Concomitant elbow dislocations and lateral condyle fractures are even rarer. There is a wide variability in the outcomes of these injuries as there is no consensus regarding its management. We report one such rare case in a 7-year-old child.Case Report:A 7-year-old child was brought to the emergency room with an alleged history of fall on outstretched hand sustaining injury to the left elbow. He was diagnosed with a posteromedial elbow dislocation, along with fracture of the lateral condyle. The patient underwent emergency reduction of the elbow under appropriate anesthesia following which there was persistence of varus and valgus instability, for which the lateral condyle was fixed with a standard pinning through a lateral approach with three Kirschner wires. The patient was immobilized for 6 weeks in a plaster, after which mobilization was started. At 3 months follow-up, the patient showed good functional outcome with full range of motion.Conclusion:We report an exceedingly rare case of concomitant elbow dislocation and fracture of the lateral condyle in children. If emergent reduction of the dislocation and anatomic reduction of the fracture is achieved, satisfactory outcomes can be expected. Delayed recovery of the elbow motion is common, but full range of motion can be expected in the long run.

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

Background: Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial. Methods: Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien–Dindo–Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS). Results: The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), “in-situ” fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2–16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement ≥5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS. Conclusion: Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures.

Surgical Treatment in Fractures of the Lateral Humeral Condyle in Children: When and Which Surgery

Surgical Treatment in Fractures of the Lateral Humeral Condyle in Children: When and Which Surgery

Fractures of the Humeral Ulnar Condyle in Children - a Rare but Complicated Injury.

Ulnar humeral condyle fractures are rare paediatric elbow fractures, classified as Salter-Harris IV paediatric elbow injuries. Due to constant radiological changes in the elbow with varying manifestation of ossification centres as well as late ossification of the trochlea, diagnosis of these injuries is challenging. To avoid long-term complications, the treating surgeon should be familiar with the rare injury picture, diagnostics and adequate therapeutic measures. The present retrospective study includes data on all paediatric cases from 2002 to 2019 with primary or secondary treatment at a paediatric traumatology centre for ulnar condyle fracture with a minimum follow-up of 12 months. Range of motion, joint stability under valgus and varus stress as well as axial ratios of the injured and uninjured side were evaluated in a clinical follow-up examination. The Mayo Elbow Performance Score was used to objectify functional results. 20 children, average age 8.6 years (4 - 13) and average follow-up time 25 months, were included. Radiological evaluation based on Jakob and Fowles classification revealed a type I fracture in three cases, a type II fracture in one case and a type III fracture in 16 cases. Three cases were treated nonoperatively with an upper arm cast. 17 children were treated with open reduction and internal fixation. Diagnosis of three fractures was delayed. No postoperative complications such as infections, nerve damage or nonunions. 15 children showed free elbow function. Three children showed slightly restricted elbow extension by less than 10° and two by 10°-20°. All children showed free pro/supination. 18 children showed a physiological and bilaterally identical arm axis compared to the uninjured side. Two children showed a slightly increased cubitus valgus with a 5 - 10° difference between sides. Radiologically, two children with delayed fracture treatment showed partial necrosis of the trochlea. The Mayo Elbow Score showed good (2) to excellent results in all children (18). Very good clinical and functional results can be expected if the injury is diagnosed without delay followed by adequate therapy. Misdiagnosis of ulnar condyle fractures can be associated with the development of nonunions and functional restrictions as well as, after operative therapy, trochlear necrosis. Children up to the age of 6 in particular are at risk of misdiagnosis due to faulty assessment of the cartilaginous trochlea.

Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings.

ABSTRACTPurposeOur goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount disease, including factors associated with this finding.Materials and methodsCharacteristics of patients with an OCD-like lesion on an imaging study [(X-ray and/or magnetic resonance imaging (MRI)] were compared with those without such a finding.ResultsOver a 12-year period, 6/63 (10%) skeletally immature patients (9/87 limbs) with Blount disease had an OCD-like lesion visible on plain radiographs. Based on available MRI, 7/37 (19%) patients or 10/53 (19%) limbs had an OCD-like distal femoral lesion. All lesions were noted in the posterior third of the weight-bearing portion of the medial femoral condyle with intact overlying articular cartilage. All patients with OCD-like lesions were followed for an average of 1.9 years (range: 1–2.6 years), and complete radiographic resolution of lesion was noted in 7/9 limbs (78%). There was no association of the presence of OCD-like lesion with early- vs late-onset disease, gender, age at imaging, laterality, magnitude of deformity [mean mechanical axis deviation (MAD) 63.3 vs 71.9 mm], mean mechanical lateral distal femoral angle (mLDFA; 91.3 vs 89.7°), and mean medial proximal tibial angle (MPTA; 71.7 vs 71.8°). Children with an OCD-like lesion tended to have a lower mean body mass index (BMI; 21 vs 36, p = 0.003).ConclusionThe overall prevalence of OCD-like lesions in the medial femoral condyle in children with Blount disease lesions is 10% using plain radiographs and at least 19% on MRI. Based on the numbers available, we were unable to demonstrate any associations between the presence of such lesions and the patient’s age, gender, or magnitude of varus deformity. Further research is needed to fully ascertain the aetiology and natural history of these benign appearing osteochondral imaging findings in children with Blount disease. Our current data support that these lesions do resolve with time and that no surgical intervention targeted at the femoral OCD-like lesion is warranted.Level of evidenceDiagnostic study Level III.How to cite this articleEdobor-Osula F, Wenokor C, Bloom T, et al. Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings. Strategies Trauma Limb Reconstr 2019;14(3):121–125.

Different classifications concerning fractures of the lateral humeral condyle in children.

Fractures of the lateral condyle are the second most frequent elbow fractures in children. Although the pathobiomechanism is well known and different fracture classifications exist, there are still adverse clinical results. This raises the questions how precise classifications predict fracture stability, especially in the context of choosing the best therapy. It also remains unclear how these classifications can be applied in practice. Seventy-five patients with a fracture of the lateral condyle were analyzed in this retrospective study. We included all patients with an age ≤ 14years admitted at a German Level I Trauma Center between 2005 and 2017. Different classifications according to Jakob, Finnbogason, Song and Hasler/v. Laer have been applied. Seventy-five patients with fractures of the lateral condyle were analyzed thereof 53 treated operatively and 22 conservatively. In sum, 6 out of 75 fractures showed no lateralization (Jakob: stable) in the first X-ray, but the same wide of the fracture gap medial as lateral (Finnbogason and Song: unstable). In 2 out of 75 patients, fracture instability occurred although it was not detected by the classification of Jakob, Finnbogason, Song and Hasler/v. Laer. Classifying fractures according to the Jakob-Classification has limitations if notable rotation without lateral displacement occurs. Hasler/v. Laer's classification appears most adequate but can sometimes not be applied due to missing X-ray 4days after trauma. The Finnbogason- and Song-Classification performs best in prediction of instability based on the X-ray at the time of accident because of considering the fracture pathobiomechanism. All in all, we recommend the classification of Hasler and v. Laer, because it is the best predictive classification.

Creating the conditions for skeletal traction in mandibular condyle fracture in children and adolescents

In this article the possibility of using the Clark appliance (Twin-block) for creating conditions for skeletal traction in case of fraction of mandibular condyle in children and teenagers is presented. The proposed method of using the double-jaw orthodontic appliance Twin-block in case of mandibular fractures with condylar displacement promotes release of traumatized condyle and mandible replacement to correct position, promotes optimal conditions for myofunctional balance, fragment consolidation and remodeling of affected temporomandibular joint.

Kirschner Wire Fixation with and without Tension Band Wiring for Treatment of Fracture of the Lateral Humeral Condyle in Children

Kirschner wires (K-wires) are commonly used to treat displaced lateral humeral condyle fracture in children. However, K-wire fixation alone is insufficient for early elbow range of motion (ROM) exercises. Fixation combined with tension band wiring (TBW) converts distraction forces into compression forces, which provides more rigid fixation than K-wire fixation alone. Here, we retrospectively evaluated clinical outcomes of patients with displaced lateral humeral condyle fracture treated with TBW or K-wires only. We identified children with lateral condyle fractures who had undergone surgery during the period from April 2000 through March 2014. Nineteen patients were classified into 2 groups according to treatment: 10 were allocated to the TBW group (TBW and K-wires) and 9 to the K-wires group. The mean interval from injury to surgery was 5.1 days in both groups. Fractures were classified by using the Jacob's and Milch's classifications. In addition, we collected and analyzed data on postoperative complications, radiological and clinical evaluations, ROM, and Flynn's criteria. Mean duration of follow-up was 14.4 months in the TBW group and 5.9 months in the K-wires group. Mean bone union time was 38.6 days and 49.8 days, respectively. Mean duration of cast/splint use was significantly longer for K-wires patients (49.8 days) than for TBW patients (35.8 days). Range of flexion at the final follow-up was significantly lower in the K-wires group. TBW fixation appears to be the optimal treatment for displaced lateral humeral condyle fracture in children, as it facilitates early active range of motion exercises.

Frequency of Secondary Dislocations of Initially non Displaced and Minimally Displaced Fractures of the Lateral Humeral Condyle in Children - Surveillance of a Treatment Algorithm.

The treatment of undisplaced fractures of the lateral humeral condyle is conservative. However, it is problematic that it is not possible to differentiate between a stable and an unstable, non-displaced fracture. A pragmatic approach is to X-ray the elbow without a cast 5 days after trauma and to compare those images with the initial ones. If there is a central increase of dislocation, then there is an indication of an unstable fracture. The dislocation can also be indicated by a translational movement, which is best observed in the border area. The aim of the study was to retrospectively determine the incidence of secondary dislocations of initially undisplaced and minimally dislocated fractures of the lateral humeral condyle in infants between 2010 and 2015. We performed a retrospective, non-randomized analysis of 75 children with initially undisplaced and minimally displaced fractures of the lateral humeral condyle between 2010 and 2015. The strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle was carried out by means of an X-ray without a cast 5 days after trauma. Further radiological controls were performed after 14 days, 4 weeks and after 10 to 12 weeks in operated children. Seven initially undisplaced and minimally dislocated fractures (9,3%) showed a secondary dislocation 5 days after trauma when a radiological control without a cast was performed. At the control 14 days after trauma there was no further secondary dislocation. The immobilization took place in an upper arm cast for a period of 4 weeks. 90% of all non-dislocated fractures of the lateral humeral condyle can be treated conservatively. It is important to find out which about 10% of children will experience a secondary dislocation safely and effectively. It has been shown that the strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle by means of a radiological control after 5 days without a cast can be effective and cost-saving. With a high degree of certainty, the unstable fracture can be detected at the radiological control 5 days after trauma. If, after 5 days, the radiological control reveals unsure finding regarding the dislocation, it is advisable to recheck the fracture in the second radiological control after 14 days.

Outcomes of anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle in children after closed treatment

The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle (SFMC) in children. Disc displacement was observed in 20 patients with 24 SFMCs (age 4–12 years) via magnetic resonance imaging. After 6 months of closed treatment (T1), the joints were categorized based on the displaced disc status as complete reduction (DCR) or incomplete reduction (DICR). Moreover, condylar remodelling was compared between the groups using cone beam computed tomography images of the TMJ obtained at T1 and at the 1-year follow-up (T2; 15 patients with 18 displaced SFMCs). At T1, 17 of 24 joints with SFMC were assigned to the DCR group and six to the DICR group; one unilateral SFMC case developed ankylosis. Condylar depth and height differed significantly between the groups at T1, but not at T2. Intra-group comparison exhibited significant changes in the condylar depth and height over time in the DICR group. Thus, most of the anteriorly displaced discs (17/24, 70.8%) achieved reduction following closed treatment. Although sustained anterior disc displacement was associated with an increased depth and reduced height of the condyle, no clinical impairment was noted unless ankylosis developed.

Treatment principles and outcome after fractures of the lateral humeral condyle in children

Fractures of the lateral humeral condyle with displacement (>2 mm; <2 mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive X‑rays. A retrospective data analysis of all lateral humeral condyles in children <16 years old treated between 2005 and 2014 was carried out. The patients were classified according to the fracture stability at the time of the incident (primarily stable or unstable) and after 4 days (secondarily stable or unstable) using conventional X‑ray images. Atotal of 89fractures of the lateral humeral condyle were treated (mean age 6.4years, range 0.9-14 years). Of the fractures 52 (58%) were initially not displaced and 37 (42%) were initially displaced. The latter underwent open reduction and stabilization by osteosynthesis (primarily stable). Of the 52 initially not displaced fractures 35 remained stable and conservative treatment in a plaster cast was performed (primarily and secondarily stable). In 8 out of 52cases asecondary displacement (>2 mm articular gap) occurred after an average of 6 days (range 3-10 days) and operative treatment was initiated (primarily stable and secondarily unstable). No follow-up x‑ray could be performed in 2 of the 52fractures and at the end of treatment the fractures healed with displacement (primarily stable and secondarily unstable). In 7 of the 52fractures operative treatment was performed although no displacement (primarily stable) was initially documented (overtreatment). The outcome of the whole study cohort was comparable with that described in the literature. Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with astable osteosynthesis must be initiated.

Closed reduction and percutaneous pinning for the treatment of lateral humeral condyle fracture

Objective The aim of the present study was to evaluate the result of treatment of recent fracture of the lateral humeral condyle in children using closed reduction and percutaneous pinning. Background Few reports have focused on closed reduction and internal fixation of fractures of the lateral humeral condyle in children. We prospectively studied closed reduction and internal fixation to determine its usefulness as the treatment for fractures of the lateral condyle of the humerus in children. Patients and methods The lateral condylar humeral fractures were classified into three groups according to the degree of displacement and the fracture pattern as determined on four radiographic views (Jacob classification). On the basis of this classification system, we prospectively treated 60 fractures and assessed the quality of closed reduction according to the criteria of Hardacre and colleagues Results All six patients of stage 1 fractures were reduced to 1 mm of residual displacement with excellent results. A total of 42, stage 2 fractures were reduced to less than 2 mm of displacement with excellent results and four patients had good results. In six patients of stage 3 had excellent results and two patients had good result. There were no major complications such as early physeal arrest, osteonecrosis of the trochlea or capitellum, nonunion, malunion or osteomyelitis. Conclusion Closed reduction and internal fixation is an effective treatment for lateral humeral condylar fractures of the humerus in children. If fracture displacement, after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.

Distal humeral flexion osteotomy for the treatment of supracondylar extension-type malunions in children.

Distal humeral extension-type malunions may occur as a complication following improper reduction of supracondylar humerus fractures. We evaluated results after distal humeral flexion osteotomies for sagittal realignment of the humeral condyle in children. Medical records and radiographs of all patients younger than 18 years of age, who underwent this procedure because of a clinically relevant lack of elbow flexion, were evaluated. In a cohort of 18 children with a mean age of 8 years at the time of surgery and a mean follow-up duration of 1 year, elbow flexion increased significantly from a mean of 101° preoperatively to 126° at the final follow-up; established radiographic parameters (e.g. anterior humeral line, humerocondylar angle) were normalized as well. The distal humeral flexion osteotomy is a reliable method to efficiently correct extension-type malunions and improve impaired elbow flexion in children.

Treatment of fractures for lateral part of humeral condyle in children – a single-center experience

Treatment of fractures for lateral part of humeral condyle in children – a single-center experience