Humeral Condyle Fractures In Children Research Articles

Screw versus Kirschner wire fixation for lateral humeral condyle fractures in children:a meta analysis

To compare screw versus Kirschner wire fixation in the treatment of lateral humeral condyle fractures in children. A systematic search was conducted in PubMed, Embase, the Cochrane library, Web of Science, China National Knowledge Internet(CNKI), Wanfang Datebase from in ception to February 2022. Studies comparing screws and Kirschner wire fixation in the treatment of lateral humeral condyle fractures in children were included. Outcome measures included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality, their excellent and good rate of fracture healing, malunion, delayed union or nonunion, infection, limitation of elbow flexion or extension(>10°) were extracted and analyzed using software Rev Man 5.3. A total of 9 retrospective studies involving 647 patients were included, with 255 patients in the screw fixation group(including screw combined with Kirschner wire) and 392 patients in the Kirschner wire fixation group. Meta analysis showed the following:infection rate in the screw group was significantly lower than that in the Kirschner wire group[OR=0.22, 95%CI(0.09, 0.56), P=0.001]. There were no significant differences between the 2 groups in excellent and good rate of fracture healing, malunion rate(P>0.05). Subgroup analysis showed that infection rate in the screw-only group was significantly lower than that in the Kirschner wire group[OR=0.18, 95%CI(0.05, 0.65), P=0.009]. For lateral humeral condyle fractures, Screw fixation alone had a lower infection rate than kirschner wire fixation and screw combined with Kirschner wire fixation. There were no significant differences in the excellent and good rate of fracture healing, malunion. In terms of postoperative efficacy and safety of internal fixation, orthopaedic surgeons are more likely to recommend screws for fixation of lateral humeral condyle fractures in children.

Long-term outcome of nonunion of the lateral humeral condyle fracture in children: a multicentre retrospective study.

Lateral humeral condyle nonunion in children is a rare condition. The treatment protocol for nonunion of lateral humeral condyle remains controversial due to the potential complication. This study reports long-term functional outcomes of the nonunion of the lateral humeral condyle fracture. In addition, we identified the prognostic factors for nonunion of the lateral humeral condyle fracture. We conducted a multicentre retrospective cohort study of nonunion of lateral humeral condyle between January 1995 and December 2022. The patient's preoperative demographic information was reviewed. Potential risk factors of poor functional outcome, such as age, duration from initial injury, and fracture displacement, were retrieved. Functional outcomes at the latest follow-up visit were evaluated using the Mayo Elbow Performance Score (MEPS). Multivariable linear regression was deployed to evaluate the association of potential risk factors with the functional outcome. A total of 63 patients from eight medical centers were included, of which 60 were surgically treated. Patients' average age was 7.3years old, with a mean follow-up duration of sevenyears. All nonunion cases were successfully treated, resulting in a normalized humeroulnar angle. The rate of AVN was 16.7%. All patients reported excellent range of motion and MEPS at the latest follow-up. Multivariable linear regression demonstrated that Fracture displacement (β = -0.88, 95% CI -1.55 to -0.22, p = 0.010) and duration from initial injury (β = -0.09, 95% CI -0.17 to -0.02, p = 0.010) were statistically significant factors influencing functional outcome of lateral humeral condyle nonunion. Initial fracture displacement and duration from the initial injury are statistically significantly associated with elbow function in lateral humeral condyle nonunion. However, the effect size for these factors is relatively small and does not reach clinical significance. Despite this, the functional outcome is excellent in all patients, with an average follow-up duration of sevenyears.

Patient-reported outcomes after operative versus nonoperative treatment of pediatric lateral humeral condyle fractures.

Lateral humeral condyle fractures in children are treated with several approaches, yet it is unclear which has the best treatment outcomes. We hypothesized that functional outcomes would be equivalent between treatment types, reduction approaches, and fixation types. Our purpose was to assess patient-reported outcomes and complications by treatment type (operative versus nonoperative), reduction approach (open versus percutaneous), and fixation type (cannulated screws versus Kirschner wires).We retrospectively reviewed data from acute lateral humeral condyle fractures treated at our level-1 pediatric trauma center from 2008 to 2017. Patients were included if they were 8 years or older and had completed clinical follow-up. Fractures were categorized by fracture severity as mild (<2-mm displacement), moderate (isolated, 2- to 5-mm displacement), or severe (isolated, >5-mm displacement or >2-mm displacement with concomitant elbow dislocation or other elbow fracture). We extracted data on patient age, sex, treatment type, reduction approach, fixation type, patient-reported outcomes (shortened Disabilities of the Arm, Shoulder, and Hand and Patient Reported Outcome Measurement Information System upper extremity), treatment complications, and follow-up duration. Patients in the operative versus nonoperative group and across fracture severity subgroups did not differ significantly by age, sex, or follow-up duration. Bivariate analysis was performed to determine whether outcomes differed by intervention. Alpha = 0.05.No differences were observed in patient-reported outcomes between operative versus nonoperative groups for the mild and severe fracture subgroups. No differences were observed between approach (open versus percutaneous) or instrumentation (cannulated screw versus Kirschner wire fixation) for any outcome measure within the operative group. Patients whose fractures were stabilized with screws versus wires had significantly higher rates of return to the operating room (94% versus 8.3%, P < .001). The overall complication rate for our cohort was low, with no differences by treatment type or fracture severity.In our cohort, patient-reported outcomes were similar across fracture severity categories, irrespective of treatment or fixation type. Patients who underwent internal fixation with cannulated screws experienced significantly higher rates of return to the operating room compared with those treated with Kirschner wires but otherwise had similar complication rates and patient-reported outcomes.Level of Evidence: 3

Complications of Lateral Humeral Condyle Fractures in Children

Lateral humeral condyle fractures in children are easily missed and often associated with complications. These complications include malunion, delayed union or nonunion, lateral spur formation, fishtail deformity and growth disturbances. There is also controversy related to best treatment options including closed vs open reduction and K-wire vs screw fixation. Though some complications like malunion are avoidable, others like lateral spur formation are inevitable. Knowledge about these complications would help in counseling patients and their families. The purpose of this article was to review common complications related to these fractures and suggest tips to avoid some of them. Keywords: Paediatric, Lateral condyle fracture, Internal oblique X-ray, Arthrogram, Anatomical reduction, Complications, Tips to overcome

Comparison of radiological and clinical outcome among Kirschner wires versus 3.5 mm diameter cannulated cancellous screw internal fixation in treatment for the displaced lateral humeral condyle fractures in children

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral humeral condyle fracture, the second most common injury around the elbow, accounts for 10-20% of all fractures of the elbow in children with a high incidence between two and 14 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This hospital based prospective randomized comparative study design was include patients of both sexes in age group of 2 to 14 years attending SMS hospital, Jaipur during April 2018 to June 2019 or till the sample size achieved, with due permission from the institutional ethic committee and review board and after taking written informed consent from the patient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 40 patients out of 50 were grouped as excellent (70.1%) while 13 were found good (22.8%) and only four patients were found poor (7.01%) as per Hardacre criteria of assessment of lateral condyle treatment in k wire group while excellent, good and poor results were found 68.4, 24.5 and 7.01% respectively in CC screw groups&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The displaced fractures (displacement over 2 mm) can be treated successfully by open reduction and K-wires or screw fixation with excellent results.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

BackgroundEvaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment.MethodsThirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared.ResultsThe mean displacement of the fractures was 3.1 mm (range, 2.0~5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837.ConclusionsUltrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures.Level of evidenceProspective study; level II.

Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department: A 10-Year Single-Center Experience.

The lateral humeral condyle fractures in children accounts for one fifth of all elbow fractures. These fractures have a propensity to displace because of the pull of the extensor muscles on the condyle. The aim of this study was to examine the epidemiology, injury patterns, complications, and predictors for conservative/surgical management in patients with lateral condyle humeral fractures between 0 and 18 years of age. This was a single-center retrospective study conducted between January 2006 and December 2016. There were 268 patients identified with lateral condyle elbow fracture. Majority of the patients (81.4%) with lateral condyle humeral fractures presented with either undisplaced or minimally displaced (<2 mm) fractures. The initial management in majority (90.7%) of the patients was conservative. Of the patients, 26.8% had secondary displacement at follow-up. The overall proportion of patients who required surgical intervention was 36.2%. Varus deformity of elbow (2.2%) and malunion (0.4%) were the complications noticed on long-term follow-up. Increased age and undisplaced fracture were statistically significant positive predictors for conservative management. The presence of concurrent elbow injuries and type of fracture (displaced >2 mm) were statistically significant positive predictors for surgical management. Our study demonstrated that majority of the patients with lateral condyle humeral fractures had presented with either undisplaced or minimally displaced (<2 mm) fractures. The positive predictors for conservative management of fractures were increased age and undisplaced fracture. The positive predictors for surgical management of lateral condyle humerus fractures were concurrent injuries in elbow and type of fracture (displaced >2 mm). Physician vigilance to the possibility of additional migration of lateral condyle fractures initially managed conservatively, and the need for subsequent surgical stabilization plays an important role in the management of these fractures.

Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow.&#x0D; Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children.&#x0D; Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al.&#x0D; Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022).&#x0D; Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

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.

Retrospective Evaluation of The Result of Fixation of Lateral Humeral Condyle Fractures by K-Wires versus Cannulated Screws in Children

Background: fractures of the lateral condyle of the humerus represent the second most common type of fracture of the elbow in children. Although this injury is seen at all ages, it is predominately observed in children aged between 5 and 10 years. Objective: the purpose of this study is retrospective evaluation of the results of fixation of lateral humeral condyle by K-wires versus cannulated screws in children by assessment of: 1-Time to full union. 2-Range of motion.3- Percentage of complications. 4-According to Hardacre criteria. Patients and methods: a retrospective study for evaluation of the result of fixation of lateral humeral condyle fractures in children by K-wires vs cannulated screws. Our series was conducted in Al-Azher University Hospitals. 20 patients with humeral condyle fractures were treated by K-wires and cannulated screws. Results: in group A patients presented by complications as following: extension lag 1 (10%), delayed union (healing at 3–6 months) 1 (10%), revision 1 (loss of reduction at the 3rd day of operation and required revision using pin fixation) (10%), fish tail deformity 0 (0%) and 7 (70%) had no complications. While in group B: extension lag 1 (10%), delayed union 2 (20%), nonunion 1 (10%) (Not healed at greater than 6 months and reoperated using bone graft and pin fixation), revision 0 (0%), fish tail deformity 1 (10%), pin tract infection 1 (10%) and 4 (40%) had no complications. Conclusion: our study supports that screw fixation may be a viable option, with no nonunions and fewer complications than pin fixation.

A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children

IntroductionManagement of minimally displaced lateral humeral condyle fractures in pediatric patients is controversial. This is primarily because with current imaging modalities it is difficult to accurately and conveniently determine the stability of the fractures by detecting the integrity of the cartilage hinge. Nevertheless, transverse ultrasonography has not been intensively reported in previous studies. HypothesisTransverse ultrasonography can determine the integrity of the cartilage hinge in minimally displaced lateral condyle fractures. Materials and methodsWe retrospectively reviewed the medical records of 39 pediatric patients with minimally displaced fractures of the lateral humeral condyle who underwent transverse ultrasonography between 2014 and 2017. Conservative treatment was given to pediatric patients with intact cartilage hinges that had been confirmed by transverse ultrasound images. Surgical treatment was recommended for pediatric patients with disrupted cartilage hinges. Data regarding healing of the lateral humeral condyle fractures were recorded and analyzed. ResultsAccording to transverse ultrasonography, there were 14 children with intact cartilage hinges and 25 children with disrupted cartilage hinges. Fourteen children with intact cartilage hinges of the fracture were treated conservatively, and none of them showed secondary displacement. There were 16 children in whom there was surgical intervention, and 9 other children decided to have conservative treatment among the 25 children with disruption of the cartilage hinge. Five of these 9 children who underwent conservative treatment were found to have further displacement during an average of 12.6 days after the fracture event, and no other patient was found to have further displacement. ConclusionTransverse ultrasonography can simply and accurately determine the stability of minimally displaced lateral condyle fractures without sedation, ionizing radiation or invasive techniques. We recommend routine use of transverse ultrasonography to detect stability of the fractures, which can effectively avoid inadequate treatment and unnecessary surgery in pediatric patients with minimally displaced fractures of the lateral humeral condyle. Level of evidenceIV, retrospective cohort study.

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

Arthroscopically Assisted Surgery for Lateral Humeral Condyle Fractures in Children; Case Series

Arthroscopically Assisted Surgery for Lateral Humeral Condyle Fractures in Children; Case Series

Relevance of MRI for management of non-displaced lateral humeral condyle fractures in children

IntroductionThe treatment for non-displaced (<2 mm displacement) fractures of the lateral humeral condyle in children is controversial. Most studies recommend non-surgical treatment. However, plain radiographs are not sufficient to evaluate extension of the fracture line through the articular cartilage. This explains the high frequency of secondary displacements and non-unions, despite well-conducted conservative treatment. We hypothesized that MRI could be used to analyse whether the fracture is complete or incomplete. This could help to determine whether surgical or conservative treatment is indicated. Material and methodsThis prospective study enrolled children being treated for a non-displaced (< 2 mm gap) fracture of the lateral humeral condyle. All patients were treated with a long-arm cast in the emergency room. An MRI was done later on without sedation. A specific protocol was used to reduce the duration of the examination. T2-weighted and proton density fat-saturated sequences were used. ResultsTwenty-seven patients were enrolled: 16 boys and 11 girls with a mean age of 5 years (2–10). The MRI was performed an average of 7 days (1–23) after the fracture. The MRI could not be interpreted in two cases because the child had moved during the examination. In the other 25 patients, the fracture was incomplete in 17 patients and complete in 8 patients. Two children had secondary displacement diagnosed 7 and 11 days after the fracture event. These two patients underwent open reduction and internal fixation. There was no correlation between patient age and the fracture being complete or incomplete. There were no cases of non-union. ConclusionMRI appears to be a reliable method for determining whether the fracture line is complete or incomplete. It can be performed without sedation, even in children as young as 2 years of age. Use of an injury-specific MRI protocol reduces the length of the examination, thereby improving its performance. We recommend that it be used to analyse non-displaced fractures of the lateral humeral condyle in children. Level of evidence3 Prospective study.

The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children.

Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication. Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury. The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture. Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.

Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children

IntroductionIn minimally displaced pediatric lateral humeral condyle fractures, plain radiography cannot be used for accurate differential diagnosis of the cartilage lesion, and other imaging methods have demerits in their accuracy and their accessibility. The purpose of this study was to investigate the usefulness of arthroscopy to diagnose cartilage displacement in minimally displaced fractures. Materials and methodsNine children with minimally displaced lateral humeral condyle fractures, an average of 6.6 years old, underwent combined arthroscopy and fixation surgery. Percutaneous fixation was performed with nondisplaced articular surface according to the arthroscopic findings, while in case of displaced fracture under arthroscopy, open fixation was preferred. The difference between the arthroscopic and radiographic findings was investigated. ResultsArticular surface could be arthroscopically visualized in all patients. Under arthroscopy, cartilage hinges were maintained in seven cases and disrupted in two. Nondisplaced cartilage disruption was noted in one of these two cases, and percutaneous fixation was performed. A displaced articular surface was noted in the other one, where the patient underwent open surgery. At the last follow-up, an average of 14.7 months postoperatively, union and wide range of motion had been achieved without any complications. ConclusionDiagnosis of fracture displacement by merely using plain radiography was considered to be insufficient for minimally displaced cases. Diagnostic arthroscopy aided in the appropriate selection of either a percutaneous or open fixation method. Level of evidenceLevel IV, therapeutic case series.

Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution.

Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob’s classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV.

Clinical results of lateral humeral condyle fractures in children

Clinical results of lateral humeral condyle fractures in children

English

BACKGROUND: Neglected fracture of the lateral condyle of distal humerus in children is very common. Patients with non union of the lateral condylar fracture have pain, instability or a progressive cubitus valgus deformity, condylar prominence. A neglected displaced lateral humeral condyle fracture remains a difficult problem to treat. The bone ends become indistinct and soft tissue becomes contracted; making anatomic reduction difficult. Moreover an attempt to mobilize the fragment by stripping the soft tissues may lead to avascular necrosis. Several authors have recommended operative treatment for such patients, while others do not recommend operative intervention because stiff elbow and AVN are the usual outcomes. The present study was undertaken to assess the results of open reduction and internal fixation in neglected lateral humeral condyle fracture in children. MATERIAL AND METHODS: This is a prospective study carried out between November 2008 and July 2011 in the department of orthopedics at Teerthanker Mahaveer Medical College and research centre, Moradabad. Eighteen patients (14M:4F) with an average age of 7.3years (range 5.5 to 14 years) who had lateral humeral condyle fracture and reported 3 or more weeks after sustaining injury, were included in the study. The fractures were classified according to the Jacobs system. All patients were operated using the lateral approach and fixation was done using K wire or screw with or without bone grafting. The results were graded as excellent, good, fair or poor according to the modified criteria of Agarwal et al. RESULTS: There were 14 males and 4 females with a mean age of 7 years and 3 months (range 4-14 years). Among the nine (50%) patients who presented between 5 to 8 weeks after injury, the results were excellent in 3, good in 4, fair in 1 and poor in 1 patient. Excellent to good results were seen in all the five (27%) patients presenting between 3-5 weeks of injury. Among four (23%) patients out of total 18 patients who presented between 9-12 weeks of injury, 2 had poor results and 1 each had good and fair results. Maximum number of patients had Jacobs type 2 fractures. In our study 25% of these patients had showed excellent results, whereas only 12.5% of patients with type 3 fracture showed excellent results. Fourteen (n=14) patients underwent internal fixation with K wire and in four patients’ fixation was done by cancellous screws. The commonest complication seen was pin tract infection (n=10), followed by occasional pain (n=5) around the elbow. There were no cases of avascular necrosis. CONCLUSION: Satisfactory functional results can be obtained even in late presenting fractures lateral condyles of the humerus in children with modification of surgical technique.

Medial humeral condyle fractures in adolescents: treatment and complications

The very rare isolated medial humeral condyle fractures in children and adolescents pose significant problems to orthopedic surgeons such as ulnar nerve injury, trochlear irregularities, fishtail deformity and motion loss. Six adolescent boys with displaced medial humeral condyle fractures with an average age of 14.8 (range 12-17) were included in this study. Patients were followed-up with a mean of 39.8 months (range 21-72). In three patients, there were clinical signs of ulnar nerve dysfunction at initial presentation. Of these, two had only mild hypoesthesia on the ulnar side. The other patient had sensory and motor loss of ulnar nerve at initial presentation complicated by hypothenar atrophy and anhydrosis during follow-up. Complete recovery was seen in this patient only at 2 years. One patient without a neurologic compliant at initial presentation developed mild hypoesthesia on the ulnarly innervated areas postoperatively with complete resolution. Medial skin incision was used for open reduction and internal fixation. No signs of gross morphologic damage were seen on the nerve. The symptoms resolved postoperatively in 3 months time in three of the patients, but in the remaining one, it took 2 years for complete resolution of the symptoms. Also, trochlear irregularity and fishtail deformity were seen on radiographs of two different patients. In all but one patients, motion loss ranging from 10° to 20° was evident on physical examination. The most important finding of this study revealed that transient ulnar nerve dysfunction was seen two-thirds of the patients in this series than any other series reported previously. In three series, only one case of ulnar nerve injury was reported from a total of 19 patients. A possible explanation for such a difference may be the older age in this series.