Lateral Condyle Fractures Research Articles

Supracondylar humeral fractures and lateral elbow condyle fractures in children: association between body weight, clinical signs, and fracture severity.

The objective of our study was to investigate the association between body weight, clinical signs and surgical time, and the severity of elbow fractures sustained exclusively by a ground-level fall in children. Patients aged 2-11 years with elbow fracture caused exclusively by a ground-level fall were included. BMI was plotted on the sex-specific BMI-for-age percentile growth chart to obtain the BMI percentile. The elbow fractures were classified according to Gartland Classification for supracondylar fractures and the Song Classification for lateral humeral condyle fracture. Our main outcome measurement was Body Mass Index and fracture severity according Gartland or Song classifications. A total of 175 patients with elbow fractures were included in this study. The mean age of total population was 5.4 years (±2.4). The majority of our patients were male (61.7%), nearly of 48% were overweight or obese patients. The ecchymosis and puckering were the clinical sign more frequent in more severe fractures. Our data presented did not observe a direct relation between obesity and the severity of elbow humeral fractures in the pediatric population with a ground-level fall.

Effect of breed as a risk factor for humeral condylar fracture in skeletally immature dogs.

To investigate the effect of breed as a risk factor associated with humeral condylar fracture in skeletally immature dogs in the UK. Retrospective study of dogs under 12 months of age that were presented with humeral condylar fracture to three specialist referral centres between 2015 and 2018. Data retrieved from medical records included breed, age, gender, neuter status, affected limb, fracture configuration and aetiology of the fracture. Breed population percentages were compared with those recorded by the UK Kennel Club. Of the 115 dogs with 118 fractures, French bulldogs (41%) and English springer spaniels (15%) were overrepresented: humeral condylar fractures were more commonly diagnosed in French bulldogs (odds ratio=5.86) and English springer spaniels (odds ratio=5.66) compared with mixed-breed dogs. Lateral condylar fractures occurred in 70% of cases, with medial condylar fractures and Y/T fractures accounting for 9% and 21%, respectively. Median age at the time of fracture was 4months (range 2 to 10months). French bulldogs and English springer spaniels were identified as being at potentially increased risk of humeral condylar fracture in skeletally immature dogs.

Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow - A Systematic Review.

ObjectiveLateral humeral condyle fractures are the second most common elbow fractures in children. Both K-wire fixation and screw fixation have been advocated as suitable treatment options for displaced fractures. This study aimed to identify which fixation method was associated with the best functional outcomes.MethodsA systematic review was conducted. Studies reporting functional outcomes following surgical fixation of lateral condyle fractures were included for review. The primary outcome measure was functional outcome. The secondary outcome measure was major complications. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies.ResultsTen retrospective non-randomised, comparative studies were eligible and included. No randomised-controlled trials were identified. The highest rate of excellent functional outcomes was seen with screw fixation (120/126 [95%]), compared with K-wire fixation (135/162 [86%]). The incidence of major complications was comparable, with complications in 6/95 (6%) of screw fixations and 6/141 (4%) K-wire fixations. A small sample of data on closed reduction demonstrated excellent functional results in 73 of 76 (96%) of patients. Closed reduction of displaced fractures is associated with a significant learning curve however.ConclusionThe evidence was of poor quality and comprised of retrospective case series. This prevented meta-analysis and any firm conclusions being drawn from the available data. Screw fixation may be associated with improved functional outcomes. Complication rates between the two methods are comparable. Further prospective studies are recommended.

Incidence, risk factors and outcomes of avascular necrosis occurring after humeral lateral condyle fractures.

Avascular necrosis (AVN) of the distal humerus is a known complication of lateral condyle fractures yet the specific rate of occurrence is unknown. The purposes of this study are to analyze the incidence, outcomes, and risk factors for AVN following lateral condyle fractures. A retrospective chart review of children diagnosed with a lateral condyle fracture between 2001 and 2014 at level-1 tertiary pediatric center was completed. Demographic data, Weiss classification, time from injury to surgery, operative vs. nonoperative management, open vs. closed reduction, and type of fixation were studied. For patients with radiographs consistent with AVN at any point in their care, elbow range of motion (ROM), pain, and deformity were measured at last follow up. Of the 500 patients evaluated, the incidence of AVN was 1.4%. All cases of AVN were following open reduction and percutaneous fixation (P = 0.01) as initial treatment. Type III fractures were significantly associated with AVN (P = 0.041). After average follow up of 59 weeks (range: 24-150 weeks), all patients regain full ROM except one patient who lacked of 15° of extension and 10° of flexion. Five patients were asymptomatic while two patients had mild pain. There was no radiographic evidence of valgus or varus deformity at final follow up. AVN following lateral condyle fractures is rare with a rate of only 1.4%. Type III fractures and open reduction were significantly associated with AVN. Provided no residual deformity and reconstitution of avascular bone, good outcomes can be expected.

Transverse Anterior Approach to the Elbow for Pediatric Displaced Lateral Humeral Condyle Fractures.

The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a better visualization of the articular fracture resulting in better functional results, less complications and a more cosmetically-appealing scar than usually seen with the lateral approach. Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCF via an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignment and complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level of satisfaction with the cosmetic appearance of the scar. Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classified as Jackob's Type II in 14 cases and Milch's type II in all cases. Mean follow-up was 12 (range 4 to19) months.Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operative complications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, active elbow ROM of at least 90%, was obtained. All parents claimed to be "very satisfied" with their child's scar. A lateral spur was identified in 66.7% o patients. The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilage reduction. Complications after this technique might decrease compared to the lateral approach but need future comparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage of this approach compared to the classical lateral approach.

Comparison of Outcome on Early and Late Initiation Of Operative Treatment in Children With Lateral Condyle Fracture of Humerus

Background: Lateral condyle fracture of humerus in children is the second most common fracture around elbow occurs less commonly than supracondylar fracture in the range of 15% to 20% that must be treated by operation. To find out the demographic variations, causes, functional movements and complications of late cases of lateral condyle fracture of humerus in children treated by open reduction and internal fixation and also comparison with early cases.
 Materials and methods: This prospective interventional study was carried out in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University and Chittagong Medical College Hospital for the duration of 03 years and 06 months. Total 24 patients of fracture lateral condyle of humerus in children age ranges from 02 to 14 years were selected but due to loss of follow up, 20 children were taken in account for the study. Total patients were divided into two groups- group I: early (Up to 4 weeks) and group II: late (5 to 12 weeks) according to time interval from injury to operative treatment.
 Results: In this study, Out of 20 patients, male (85%) were more than female (15%) left side involvement was 60% and right side was 40%. Among causes of injury, 55% was due to sports injury, 30% was fall from height and 15% from RTA. 35% initially treated by plaster cast, 60% by traditionally bone setter. 55% were misdiagnosed, complications were 10% in group I and 30% in group II. Outcome was satisfactory with 100% in group I and 70% in group II.+
 Conclusion: Outcome was better in early cases by operative treatment but late cases up to 12 weeks should be treated by operation.
 JCMCTA 2019 ; 30 (2) : 10-15

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.

Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures. Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries. Study Design: Case series; Level of evidence 4. Methods: Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing. Results: There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02). Conclusion: Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.

Open Reduction and Pin Fixation of Pediatric Lateral Humeral Condylar Fractures.

Lateral condylar fractures of the humerus are the second most common elbow fracture seen in pediatrics, behind supracondylar humeral fractures. All practicing orthopaedic surgeons should be able to identify and treat these injuries appropriately, as the intra-articular and transphyseal nature of this fracture pattern contributes to the relatively high complication rate. Treatment has evolved with time as classification systems better characterize the different types of lateral condylar fractures, aiding in decision-making for management. This video article reviews the diagnostic findings and classification systems for lateral condylar fractures and then details the surgical technique for open reduction and internal fixation of displaced lateral condylar fractures. Position the patient supine with the arm extended on a hand table with a sterile tourniquet. Center the incision over the capitellum. Follow the rent in the fascia to the fracture. Open the capsule anteriorly to view across the joint, avoiding excess posterior dissection to protect the blood supply. Clear soft tissue from the anterior surface of the fracture fragment, which will allow visualization of the fragment without excessive posterior dissection. Using a long retractor anteriorly to maintain visualization of the articular surface, reduce the fracture with a valgus force. Insert 2 pins percutaneously posterior to the incision. One pin should be parallel to the joint surface; the other should diverge >45° and fixate the medial metaphysis. Confirm reduction by direct visualization as well as by anteroposterior, lateral, and internal oblique radiographs. Cut and bend the pins outside the skin and close the incision with absorbable suture. Apply a long-arm cast. Nonoperative management is reserved for fractures with <2 mm of displacement. Closed reduction can be attempted for fractures with 2 to 4 mm of displacement. Screw fixation may be utilized in some cases. Management of fractures displaced 2 to 4 mm is controversial and surgeon-dependent. Although cast immobilization for these fractures has been reported historically as successful1, close follow-up is required as these fractures can have late displacement. Many authors have a low threshold for operative intervention if close follow-up cannot be guaranteed or if there is concern for increasing displacement2. Both closed reduction and percutaneous pinning with an arthrogram and open reduction with direct visualization and fixation are acceptable treatment methods3. There is consensus that surgery is warranted for a displaced lateral condylar fracture with malrotation or articular incongruity. Although there is 1 report of percutaneous reduction and fixation in substantially displaced fractures4, most surgeons perform open reduction with either pin or lag screw fixation for fractures displaced >4 mm. Although lag screw fixation is biomechanically superior5 and has higher union rates6,7 and lower infection rates8, a second surgery is necessary for implant removal because of growth concerns9. Bone union and good clinical results can be obtained in children with a lateral condylar fracture10. Lateral overgrowth in the form of a "lateral spur" and cubitus valgus are the most common residual deformities seen10. Nonunion, osteonecrosis, fishtail deformity, and ongoing range of motion limitations are seen less commonly in lateral condylar fractures11-13. Reserve nonoperative management for minimally displaced fractures that can be followed closely.An arthrogram is required for closed reduction to ensure joint surface congruity.Avoid posterior dissection as it risks the blood supply to the distal fragment.Counsel parents that lateral overgrowth is to be expected and results in no functional limitations to the patient.

Anterolateral Versus Posterolateral Approach for Lateral Condylar Fractures of the Humerus in Children.

Background:Two surgical approaches, an anterolateral and a posterolateral approach, have been advocated for lateral condylar fractures (LCFs) of the humerus in children. The purpose of this study was to evaluate the radiographic and clinical outcomes of the 2 surgical approaches.Methods:We retrospectively analyzed the data of consecutive patients <15 years of age with an LCF treated via open reduction and internal fixation through 1 of 2 surgical approaches during the period of April 2000 to March 2019. Patients were classified into the anterolateral (AL) and posterolateral (PL) groups, according to the surgical approach used. Postoperative complications and radiographic and clinical findings (including range of motion and findings on the basis of the Flynn criteria) were investigated. To investigate humeral deformity, the Baumann angle and the carrying angle were measured on anteroposterior radiographs.Results:Sixty-one of 82 patients met the inclusion criteria. The AL group included 17 patients (13 male, 4 female), and the PL group included 44 patients (28 male, 16 female). In the PL group, 7 patients had cubitus varus deformity, 3 had malunion due to unacceptable reduction of fracture fragments, and 6 had elbow joint contracture. In the AL group, the overall clinical results were excellent for 15 patients and good for 2. In the PL group, the clinical results were excellent for 12 patients, good for 14, fair for 6, and poor for 12.Conclusions:An anterolateral approach would be the optimal approach for an LCF in pediatric patients.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

To evaluate Clinico-radiological and functional outcome of “early mobilization” after stable internal fixation with k-wires in displaced fracture of lateral condyle humerus in children

Background: Lateral condyle fractures are the second most common pediatric elbow fractures, after those of the supracondylar region. They account for approximately 16.9% of those occurring in the upper limb. Most of them need to be managed operatively by open reduction and internal fixation with Kirschner wires followed by Splintage in an above elbow slab for at least 4 to 6 weeks. The present study was conducted to evaluate the functional outcome of early mobilization after stable internal fixation with 3 Kirschner wires. Methods: A prospective study was conducted including 30 patients having displaced fracture of lateral condyle humerus in children over a period of one year. All the patients were followed up for a minimum of 6 months. Age incidence, sex distribution, mode of injury, side involved, fracture classification, complications and functional outcomes were noted. Results: There were 22 males and 8 females. Average age was 6.18 years. 22 of them were Jakob III and 8 were Jakob II. Early mobilization was started in all patients from first post operative day. All fractures united by 6 weeks at time of wire removal. At the final follow up Dhillon functional score was evaluated and was found to be excellent in 24 patients, good in 5, fair in one and there was no patient with poor outcome. Conclusion: Our results demonstrate that displaced fractures of lateral condyle humerus managed operatively by open reduction and stable fixation with 3 K-wires can be mobilized immediately after surgery without any risk of loss of reduction and with good final functional results.

Current Concepts in the Treatment of Lateral Condyle Fractures in Children.

Lateral condyle fractures of the humerus are the second most common fracture about the elbow in children. The injury typically occurs as a result of a varus- or valgus-applied force to the forearm with the elbow in extension. Plain radiographs are sufficient in making the diagnosis; however, an elbow arthrogram permits optimal visualization of the articular surface in minimally displaced fractures. Traditionally, nonsurgical management is indicated for fractures with ≤2 mm of displacement and a congruent articular surface. Closed reduction and percutaneous pinning is performed for fractures with >2 mm of displacement with an intact cartilaginous hinge at the articular surface. Open reduction and internal fixation is often necessary for fractures with ≥4 mm of displacement or if there is articular incongruity. Complications include malunion, delayed presentation, fishtail deformity, lateral spurring, and growth arrest. Evolving management concepts include relative indications for surgical management, the optimal pin configuration, and the use of cannulated screw and bioresorbable fixation.

Anterior dislocation of the elbow with lateral condyle fracture in a child: A rare concomitant injury

Elbow dislocation in children is a rare injury and the anterior dislocation is a rarer variant. These may at times be associated with fractures of condyles or epicondyles of the distal humerus among others. An anterior elbow dislocation along with concomitant fracture of the displaced lateral condyle is a very rare injury, which was successfully managed and is described here with relevant details. Anterior elbow dislocation in a 7-year-old child was reduced, and the lateral condyle fracture was managed by open reduction and K-wire fixation. Good functional outcome was noted despite radiological irregularity over the capitellum with child performing all activities of daily living.

Simple method of differential diagnosis between lateral condylar fracture and epiphyseal separation of distal humerus in children based on the direction of displacement of distal lateral metaphyseal fragment

Simple method of differential diagnosis between lateral condylar fracture and epiphyseal separation of distal humerus in children based on the direction of displacement of distal lateral metaphyseal fragment

Elbow Dislocation with Lateral Condyle Fracture of the Humerus in Children

Elbow Dislocation with Lateral Condyle Fracture of the Humerus in Children

Outcome of Lateral Condyle Fracture of Humerus in Children Treated with Open Reduction and Internal Fixation

Introduction: Lateral condyle fracture is one of the commonest injuries encountered in pediatric age group. There is no unanimity regarding the method of treatment, however closed reduction is not applicable to all cases and have failure rates making open reduction and internal fixation (ORIF) as the treatment of choice at least in displaced fractures. There are a number of options during surgical management of these fractures; Kirschner-wire (K-wire) is the most commonly used implant for fixation. The purpose of our study was to evaluate the results of lateral condyle fractures of humerus in children treated by ORIF by K-wires based on Hardacre criteria.&#x0D; Materials: This prospective study was conducted in the department of orthopedics in Nepalgunj Medical College Teaching Hospital, Kohalpur from May 2016 to October 2018. All of the fractures in this study were treated by ORIF with unburied K-wires. It included 37 children of age group upto 14 years. Children were evaluated for age, sex, side of arm involved, mechanism of injury, type of fracture, presence of additional injuries, implant removal time, outcome and accompanying complications. K-wires were removed after clinico-radiological union of the fractures. Patients were evaluated using the Hardacre criteria in follow up till 6 months.&#x0D; Result: In this study of 37 children, 28 (75.7%) were males and 9 (24.3%) were females. All of them were 14 years of age or less with mean age of 6.7 ± 0.316. Majority of fractures (67.6%) were observed between six to ten years of age. Left side was predominantly involved (62.2%). Milch type I fracture was found in 5 (13.5%) children while Milch type II fracture were observed in 32 (86.5%) children. The final outcome and functions were evaluated using Hardacre criteria in which 27 (73%) cases had excellent result and all cases had good result as per Hardacre criteria. The complications were 10 (27%) cases of lateral spur; eight (21.6%) cases of hypertrophied scar and four (10.8%) cases of pin track infection and 2 (5.4%) of cubitus varus.&#x0D; Conclusion: The treatment of displaced lateral condyle fracture of humerus by open reduction and unburied K-wire fixation is safe, easy and cost effective procedure with good results. This modality of treatment provides good results among pediatric population without the need for second admission for implant removal.

Prospective Evaluation of a Treatment Protocol Based on Fracture Displacement for Pediatric Lateral Condyle Humerus Fractures: A Preliminary Study.

To prospectively evaluate a displacement-based classification system and an outcome-derived algorithm in the treatment of children with lateral condyle fractures. All children with a lateral condyle fracture were prospectively enrolled at our institution between 2013 and 2016. Fractures were classified and treated on the basis of the following classification system: type 1: <2 mm; treated with long arm casting, type II: 2 to 4 mm; treated with closed reduction and percutaneous pinning (CRPP), and type III: >4 mm; open reduction and percutaneous pinning (ORPP). Functional outcomes were assessed at 6 to 12 weeks and at 1-year follow-ups using the Pediatric Outcomes Data Collection Instrument (PODCI). A total of 55 patients (mean age, 6 y; range 2 to 12 y) were prospectively enrolled. There were 17 (31%) type I fractures treated with a long arm cast, 8 (15%) type II treated with CRPP, and 30 (54%) type III treated with ORPP. Postoperative complications included delayed union (N=5) and pin site infection (N=3). Delayed unions on the basis of fracture type was type I (1/17, 6%), type II (1/8, 13%), and type III (3/30, 10%) (P=0.85). The rate of delayed unions in type II and III fractures fixed with k-wires was 11% (4/38). Four patients required a second operation with screw fixation. No significant differences were found across PODCI domains at 1-year follow-up when comparing our study population with normative data. This is the first prospective study of a treatment protocol for pediatric lateral condyle fractures and validates the use of displacement as a guide for best evidence-based treatment. Children with a lateral condyle fracture can achieve excellent functional outcomes in all classification types with comparable complication rates when radiographic fracture displacement is used to guide surgical and clinical decision making. Level II.

Impact of Transverse Ultrasound Images on the Classification and Treatment of Pediatric Lateral Humeral Condyle Fractures.

Pediatric lateral humeral condyle fractures (LHCFs) are sometimes misdiagnosed and inappropriately treated on the basis of x-ray radiographs because cartilage cannot be seen on radiographs. However, as a useful technique, transverse ultrasonography can accurately and readily determine the integrity of the cartilage hinge in pediatric LHCFs. The purpose of this study was to assess the reliability of the Jakob classification, the treatment plan, and the necessity for further examination of pediatric LHCFs with the use of x-ray with and without transverse ultrasound images. Five pediatric orthopaedic surgeons with different levels of experience evaluated 62 cases on the basis of the use of x-ray alone and x-ray combined with transverse ultrasound images. These 2 types of evaluations were repeated after an interval of 4 to 6 weeks. At the time of each evaluation, all observers were asked to classify the fractures according to the Jakob classification, to formulate treatment plans, and to determine whether further examinations were required. After the training of transverse ultrasound image interpretation, the interobserver reliability of the Jakob classification significantly improved from fair (a kappa of 0.54) to moderate (a kappa of 0.71) with the addition of transverse ultrasound images. The treatment plan was changed from conservative treatment to surgical treatment in 7% of the ratings but from surgical treatment to conservative treatment in 15% of the ratings after reviewing the ultrasound images, and the difference was statistically significant (P=0.003). The use of the Jakob classification and a treatment plan for pediatric LHCFs can be optimized by the addition of transverse ultrasound images, especially after training for transverse ultrasound image interpretation. Level III-diagnostic study.

The Utility of Intraoperative Arthrogram in the Management of Pediatric Lateral Condyle Fractures of the Humerus.

Intraoperative arthrograms are commonly used in conjunction with closed reduction and percutaneous pinning (CRPP) of pediatric lateral condyle fractures of the humerus. The authors sought to determine how arthrograms affect management of these fractures. They reviewed all lateral condyle fractures treated surgically at a pediatric level I trauma center from 2008 to 2014. They stratified patients managed with and without an arthrogram as well as by timing of arthrogram. The authors compared injury parameters, initial and postoperative fracture displacement, and complications between groups. They identified 107 patients who were taken to the operating room for attempted closed reduction, which they classified as either CRPP without arthrogram or arthrogram first and then a decision to treat open or with CRPP. Fifty-eight (54.21%) underwent CRPP without arthrogram and 49 (45.79%) underwent arthrogram. Of those who had arthrograms, 27 (25.23%) were prior to fixation and 22 (20.56%) were after fixation. There was no difference in age, weight, or preoperative displacement among the groups. Mean postoperative displacement was significantly lower in the no arthrogram group vs the arthrogram group (0.91 mm vs 1.68 mm; P<.0001), but it did not differ based on timing of arthrogram (P=.836). Arthrograms changed management in 4 (8%) of 49 patients who had them. There was no statistical difference in the rate of changed management by timing of arthrogram (before vs after fixation, 14.8% vs 0%; P=.060). The authors demonstrated that arthrograms may be useful for assessing final fracture alignment after CRPP, but are unlikely to result in a treatment change and are not associated with improved postoperative alignment. [Orthopedics. 2020; 43(1):30-35.].

Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children.

Background:Lateral humeral condyle fractures are the second most common elbow fracture in children. Displaced and rotated fractures require stabilization and reduction. Kirschner wires (K-wires) are most commonly used in the fixation of these fractures. Here, we introduce a new fixation method that uses an absorbable screw. We aim to determine if it is feasible to treat lateral humeral condyle fractures with an absorbable screw by comparing functional outcomes following absorbable screw fixation vs. K-wire fixation.Methods:Between May 2007 and September 2010, 86 patients were treated with absorbable screws (43 patients) or K-wire (43 patients). All patients had been diagnosed with lateral condyle fractures that were classified as either Jacob type II (unstable) or III. One absorbable screw (3.5 mm-diameter) was used for fixation in 1 group, while two 1.6 to 1.8 mm K-wires were used in the other group. Patients were followed 6 months about the elbow function according to Broberg and Morrey standard. On 5–7 years, the patients were followed about the carrying angle (valgus deformities and varus deformities), range of motion (flexion loss and extension loss), prominent lateral condyle, symptomatic implants, and fishtail deformity.Results:Anatomic reduction was achieved in all patients. Each group had one radial nerve injury that were present preoperatively. Nerve function recovered spontaneously within 3 to 4 weeks of surgery in both patients. No patient developed necrosis of the capitulum in both groups. Nine patients in K-wires group and 2 in absorbable screw group developed symptomatic implants (P = .048). On the sixth month, there was no significant difference on elbow function according to Broberg and Morrey standard. On 5 to 7 years (average, 6.7 ± 1.3 years), valgus deformities was 6.8 ± 1.2 vs 5.7 ± 0.8, varus deformities was 7.2 ± 1.5 vs 5.1 ± 1.9, flexion loss was 12.4 ± 2.2 vs 9.5 ± 3.1, extension loss was 11.1 ± 3.1 vs 10.2 ± 2.7, prominent lateral condyle was 27.9% vs 37.2%, fishtail deformity was 7.3% vs 4.9%, no significant difference between these groups.Conclusions:Open reduction with absorbable screw fixation is feasible and safe for the treatment of lateral condyle fractures of the humerus in children.Level of Evidence:Therapeutic III.