Lateral Condyle Fractures Research Articles

Fractures of the Humeral Condyles in Children – A Review

The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%). The mechanism of injury varies, but the most commonly described mechanism involves a fall on an outstretched hand with varus, valgus or rotational force or a combination thereof. The vectors of force and the degree of chondro-osseous development dictate the type of injury incurred. A review of the literature was conducted to see the most frequent injuries and complications.

Cannulated screw versus Kirschner-wire fixation for Milch II lateral condyle fractures in a paediatric sawbone model: a biomechanical comparison.

PurposeLateral condyle fractures of the humerus are common in the paediatric population, accounting for up to 20% of elbow fractures. Traditional management involves internal fixation with Kirschner (K)-wires, however, this has been associated with complications and insufficiently rigid fixation. Recently, cannulated screws have been proposed as a more stable method of fixation. While cannulated screws have been thought to allow earlier range of movement and shorten time to union, data regarding the biomechanical performance and optimal screw placement is scarce. We hypothesize that cannulated screw fixation is superior to K-wire fixation and screw placement can enhance the stability of the construct.MethodsPaediatric humerus sawbones with Milch II fractures were fixed with one of three methods. Fractures were reduced with either a single cannulated screw either through the centre of the capitellum (oblique), or placed up the lateral column across the growth plate (lateral), or fixed with two K-wires. Fixed sawbone fractures were then mechanically tested in two directions simulating in vivo forces.ResultsThe lateral screw construct had a higher maximum force to failure, higher stiffness and absorbed higher energy as compared with the K-wire fixation and oblique screw under an anterior force. When loaded from the posterior direction, only the lateral column screw was better than K-wire fixation.ConclusionsScrew fixation is a biomechanically effective alternative to K-wire fixation, especially when placed up the lateral column of the distal humerus. Further clinical studies are required before transcapitellar screw fixation can be adopted.

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

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

Surgical Results of Posteolateral Approach for Pediatric Lateral Humeral Condyle Fractures

Surgical Results of Posteolateral Approach for Pediatric Lateral Humeral Condyle Fractures

Dislocation of the Elbow with Specific Lateral Condyle Fracture of Humerus; A Case Report

Dislocation of the Elbow with Specific Lateral Condyle Fracture of Humerus; A Case Report

Assessment of Functional and Radiological Outcome of Proximal Lateral Condyle Fracture of Tibia (Schatzker Type 1, 2 and 3) Fixed with Locking Compression Plate and Screw

Assessment of Functional and Radiological Outcome of Proximal Lateral Condyle Fracture of Tibia (Schatzker Type 1, 2 and 3) Fixed with Locking Compression Plate and Screw

Percutaneous K wire fixation in pediatric lateral condylar fractures of humerus: A prospective study

BackgroundWe evaluated the radiographic and clinical functional results of K-wire fixation in the treatment of displaced lateral condyle fractures of the humerus. Materials and methodsA prospective longitudinal study was undertaken in our hospital during the period December 2010•December 2014. A total number of 85 children (18 girls and 67 boys) mean age 7.76 years; range 2•13 years with displaced (>2mm) lateral condyle fractures of the humerus. All the patients were treated by close reduction and internal fixation with two K-wires for three weeks. The fractures were classified according to the criteria by Milch and Badelon and functional results were evaluated according to the criteria by Hardacre et al. The mean follow-up period was 24 months (range 20•28 months). ResultsAll children achieved union in a mean time of 3 weeks (range from 2.5•6 weeks). Functional results were excellent in 91.75% children and good in 7.05% children. Full range of elbow motion was achieved in all the patients. None of the patients had instability postoperatively. Post-operatively, 5.88% children got pin tract infection, which was superficial and healed after removing pins and oral antibiotic administration. ConclusionPercutaneous K-wire fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in children. If fracture displacement after closed reduction exceeds 2mm, open reduction and internal fixation is recommended.

Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated tenpatients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24months. Only childern with post-operative follow up more than 24months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3months with average post-operative follow up of 44.3months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p < 0.05). All six patients that had pre-operative various degrees of ulnar nerve affection had completely improved at last follow up. The osteotomy site united in an average time of 43days, whereas the LHC nonunion site united in an average time of 77.2days. The osteotomy site united in significantly less time than the LHC non-union site (p < 0.05). The correlation between time since injury and time of union of LHC non-union site was significant (p < 0.05). Post-operative elbow range of motion was not changed in five patients, slightly decreased in four patients, and increased in one patient. Three patients had an average 6.7 degrees (range; 5-10) loss of the last degrees of flexion. One patient developed extension lag of 10 degrees. The mean elbow range of motion (ROM) pre-operatively was 139 ± 4.6 degrees while the mean post-operative ROM was 138 ± 5.3 degrees. The difference was found to be statistically insignificant (p > 0.05). The mean pre-operative Mayo elbow performance score was poor 55 ± 9.7, four patients had fair score, and six had poor score. The mean post-operative Mayo elbow performance score was excellent 92.5 ± 10, six patients had excellent score, and four had good score. The improvement of the Mayo score at the last follow up was found to be statistically significant (p < 0.05). No intra-operative complications were recorded during any of the procedures and no patient developed a wound or pin track infection post-operatively. At the last follow up, none of the patients had developed avascular necrosis of the LHC. Preservation of the blood supply of the nonunited fragment is the key to successful management. This combined technique successfully addresses different aspects of the problem simultaneously and provides a durable solution without deterioration of the results over time. The para-triceptal approach provided excellent exposure of both sides of the elbow with minimal disruption of the triceps muscle.

A systematic review and meta-analysis of adverse outcomes following non-buried versus buried Kirschner wires for paediatric lateral condyle elbow fractures.

PurposeFractures of the lateral condyle of the humerus in children are a common injury. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). K-wires are placed using either an open or closed technique. The decision to bury or leave the ends extending through the skin is surgeon-dependent and based on factors including post-operative infection risk, bony union and ease of wire removal.MethodsWe performed a systematic review and meta-analysis of non-buried versus buried K-wires for lateral condyle elbow fractures in children in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A comprehensive search strategy included Medline, Embase and CINAHL via NICE Evidence from database inception to June 2017. Two authors independently reviewed, included or excluded articles, extracted data and assessed for quality with the ROBINS-I tool. We performed direct comparison meta-analysis for all adverse events, post-operative infection and failure of bony union.ResultsThree studies were analysed comprising of 434 participants. There was a significantly reduced relative risk of adverse events in the non-buried group, equating to approximately 45% reduced risk (RR 0.55, 95% confidence interval 0.34 to 0.88). There were no significant differences in risk of post-operative infection or failure of bony union. All three cost-analyses in the included studies observed savings with non-buried K-wires.ConclusionNon-buried K-wires for lateral condyle elbow fractures convey a lower risk of adverse events and may be more cost-effective compared with buried K-wires. Non-buried K-wires do not appear to increase the risk of infection or failure of bony union. These findings are limited by a high risk of bias due to inherent methodological flaws in the design of included studies.

Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population.

This study was conducted to explore epidemiologic features of traumatic elbow dislocation with associated fractures in pediatric population following appropriate treatment options.Incidence of elbow dislocation with associated fractures was analyzed in 67 children using elbow radiographs. Treatment for the displaced elbow joint was performed by closed reduction and proper immobilization. Surgical intervention was applied to restore the correct alignment of the fracture. Mayo Elbow Performance Score (MEPS) was used to measure elbow joint function.Incidence of pure dislocation was observed in 7 of 67 children (10.45%). Elbow dislocation was typically accompanied by a single or multiple fractures in 39 (58.21%) and 21 (31.34%) of 67 children, respectively. In contrast, lateral humeral condyle fracture and medial humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow fractures. All children with elbow fracture-dislocations received surgical intervention by open reduction and internal fixation. During follow-up, 56% to 92% of children displayed significant recovery of elbow function with improving MEPS after the displaced elbow and fractured fragments were reduced and held in place for weeks. There were statistical differences in MEPS between the types of fractures (P < .05 or P < .01).Incidence of isolated elbow dislocation without fracture is low; rather, it is frequently associated with fractures. Early surgical intervention achieves stable fixation and bony union with utility in improving elbow function in the pediatric population.

Common Paediatric Elbow Injuries.

Background:Paediatric elbow injuries account for a large proportion of childrens’ fractures. Knowledge of common injuries is essential to understanding their assessment and correct management.Methods:A selective literature search was performed and personal surgical experiences are reported.Results:We have described the assessment and management of the five most common paediatric elbow injuries: supracondylar humeral fractures; lateral condyle fractures; medial epicondyle fractures; radial head and neck fractures; radial head subluxation.Conclusion:Understanding of the ossification centres around the paediatric elbow is essential to correctly assessing and managing the common injuries that we have discussed in the review. Outcomes after these injuries are usually favourable with restoration of normal anatomy.

Fijación percutánea del alambre K en las fracturas condilares laterales pediátricas del húmero: un estudio prospectivo

BackgroundWe evaluated the radiographic and clinical functional results of K-wire fixation in the treatment of displaced lateral condyle fractures of the humerus. Materials and methodsA prospective longitudinal study was undertaken in our hospital during the period December 2010-December 2014. A total number of 85 children (18 girls and 67 boys) mean age 7.76 years; range 2-13 years with displaced (>2mm) lateral condyle fractures of the humerus. All the patients were treated by close reduction and internal fixation with two K-wires for three weeks. The fractures were classified according to the criteria by Milch and Badelon and functional results were evaluated according to the criteria by Hardacre et al. The mean follow-up period was 24 months (range: 20-28 months). ResultsAll children achieved union in a mean time of 3 weeks (range: 2.5-6 weeks). Functional results were excellent in 91.75% children and good in 7.05% children. Full range of elbow motion was achieved in all the patients. None of the patients had instability postoperatively. Post-operatively, 5.88% children got pin tract infection, which was superficial and healed after removing pins and oral antibiotic administration. ConclusionPercutaneous K-wire fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in children. If fracture displacement after closed reduction exceeds 2mm, open reduction and internal fixation is recommended.

Two and Three-Dimensional CT Mapping of Hoffa Fractures.

Hoffa fractures, coronal-plane fractures involving the distal femoral condyles, are unstable, intra-articular fractures. The aim of this study was to define the location and frequency of fracture lines and comminution zones in Hoffa fractures using computed tomography (CT) mapping in both 2-dimensional and 3-dimensional contexts. Seventy-five Hoffa fractures (OTA/AO types 33B3.2 and 33B3.3) were retrospectively reviewed. The directions of fracture lines were characterized in the axial and sagittal CT planes. CT images for all fractures were superimposed on one another and oriented to fit a standard template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes was performed. A 3-dimensional map was created by reducing reconstructed fracture fragments to fit to a model of the distal aspect of the femur. This study included 1 bicondylar and 74 unicondylar (26 medial and 48 lateral) Hoffa fractures. Comminuted fractures accounted for 35.5% of all fractures and 44.9% of lateral fractures. Axial fracture mapping demonstrated that fracture lines were concentrated in the middle-third area of the lateral condyle but were less concentrated and with greater variation in the medial condyle. The mean angle of fracture lines with respect to the posterior condylar axis was 34.4° and 29.0° in the lateral and medial femoral condyles, respectively. Sagittal fracture mapping also demonstrated that fracture lines were concentrated in the middle third of the lateral condyle but were less concentrated in the medial condyle. The mean angle of fracture lines with respect to the posterior cortex of the distal femoral shaft was 23.1° and 19.3° in the lateral and medial condyles, respectively. Three-dimensional mapping demonstrated comminution zones commonly occurring in the weight-bearing zone of the lateral condylar articular surface. Hoffa fractures occurred more frequently in the lateral femoral condyle. In the axial plane, fractures commonly extended from anterolateral to posteromedial in the lateral condyle and from anteromedial to posterolateral in the medial femoral condyle. In the sagittal plane, fractures traversed from anteroinferior to posterosuperior. Articular comminution was more commonly seen in lateral condylar fractures and concentrated in the weight-bearing zone of the articular surface. Research in this area is imperative for optimal preoperative planning, such as for the selection of surgical approach and fixation constructs. Our findings lend insight into fracture morphology, which can assist with fracture classification and the design of biomechanical studies, ultimately aiding in treatment.

A 3-Dimensional Analysis of the Fracture Planes in Pediatric Lateral Humeral Condyle Fractures for Image-Based Pin Positioning During Fixation.

To determine the 3-dimensional morphology of pediatric lateral condylar physeal fractures using 3-dimensional computed tomography (3D-CT) and to identify optimal pin positions for percutaneous pinning. Prospective case series of consecutively treated patients. Tertiary university hospital setting. Preoperative 3D-CTs in pediatric surgical candidates diagnosed with lateral condylar physeal fractures. Closed reduction and percutaneous pinning was performed. Reconstructed images of the distal humerus were aligned accordingly to determine the coronal (α), sagittal (β), and axial tilt (γ) angles of the fracture plane. Both α and β were also measured on plain radiography. Image-based position of the 2 pins was calculated preoperatively using 3D-CT, based on anteroposterior and lateral views. Final angle of pins was measured on postoperative radiographs. A total of 29 fractures were assessed. 3D-CT reconstruction images of fractures showed a posterolateral fracture fragment with reference to the long axis of the humerus. The mean α, β, and γ were 62 degrees [95% confidence interval (CI), 59-64], 69 degrees (95% CI, 65-72), and 36 degrees (95% CI, 34-38). Both α and β measured on plain radiography were not significantly different from 3D-CT measurements (P = 0.6712, 0.6218). Average postoperative pin angles were 144 degrees (95% CI, 140-147) and 161 degrees (95% CI, 158-165) for the proximal pin, and 118 degrees (95% CI, 114-122) and 115 degrees (95% CI, 110-120) for the distal pin, on anteroposterior and lateral views, respectively, resulting in similar trajectories to the preoperatively calculated pin positions. Our study adds to the current knowledge by providing an image-based angular reference of the fracture configuration in pediatric lateral humeral condyle fractures, which may be used during percutaneous pinning. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Late presenting lateral condyle fracture of the humerus in children - clinical outcome of surgical fixation

Aim: To assess the surgical outcome of Late presenting lateral condyle fracture of the humerus in children with open reduction k-wire/cancellous screw fixation. Material and Methods: After obtaining approval of the ethics committee, a prospective study was conducted in the department of orthopedics Navodaya Medical College and research center, Raichur from March 2015 to August 2016. 13 cases of Late presenting lateral condyle fracture of the humerus in children underwent surgery with k-wire/cancellous screw fixation. We evaluated scoring system proposed by Dhillon et al. to determine the outcomes. Results: There were 9 males and 4 females with a mean age of 7 years and 3 months (range 4-13 years). The average time interval between injury and internal fixation was 4.1 weeks. (Range 3 weeks to 7 weeks). In our study 5 patients got Excellent; 6 patients Good; 2 patients Fair; and 1 patient got Poor results. We encountered major complication in 1 patient who devolved AVN lateral condyle of humerus. Minor complications were noted in total 5 patients. Pin tract infection was the most common in 3 patients and one patient had residual flexion deformity of 15 degree with ROM of 110 degree and another patient had stiffness of elbow. Conclusion: We conclude from our study that late presenting fracture of lateral condyle of humerus needs surgical intervention which can be reasonably reduced and union achieved obtaining satisfactory functional outcome.

Surgical Treatment of Displaced Lateral Condyle Fractures of the Humerus Via the Posterior Approach

Surgical Treatment of Displaced Lateral Condyle Fractures of the Humerus Via the Posterior Approach

Arthroscopic Management of Elbow Fractures and Dislocations

Arthroscopic management of fractures and dislocations of the elbow encompasses a set of evolving techniques that are often advantageous in the treatment of these challenging injuries. The arthroscopic approach allows for direct visualization of fracture patterns and reductions without an open exposure, minimizing soft tissue trauma to a region notorious for complications. Advantages of the arthroscope include accurate assessment of fracture and associated soft tissue injury, debridement of hematoma at the fracture site, visualization of anatomical reduction, and immediate assessment of fixation stability. Arthroscopy of acute injuries is not without risk. The anatomy is altered and neurovascular structures are at risk of iatrogenic injury if not protected. Using a prone position, the arthroscopist may gain access to the medial or lateral elbow and address an array of fractures. Radial head fractures may be reduced and initially stabilized using Kirschner wires followed by percutaneous cannulated screw fixation. Comminuted fractures may be excised arthroscopically. There are multiple techniques to arthroscopically stabilize coronoid fractures—larger fragments are fixed with cannulated screws and smaller fragments may use suture anchors or suture cerclage for fixation. Capitellar fractures may be fixed with headless or buried screws from the articular surface or percutaneous screws from the posterior humerus after arthroscopic reduction. New suture fixation techniques are possible for osteochondral fragments from the capitellum. Common pediatric injuries, lateral condyle, and radial neck fractures, may also benefit from arthroscopically assisted reduction. Combination injuries from severe fracture dislocations may rely on arthroscopy to fully define the injury and systematically address fixation. Additionally, lateral instability resulting from elbow dislocations may be addressed with arthroscopic repair of the lateral ligament complex.

Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures: A meta-analysis.

Open reduction and internal fixation with Kirschner (K) wires has been reported as an efficient and convenient technique for pediatric lateral condyle distal humeral fractures. However, no single study has been large enough to definitively determine whether the K-wires should be buried or unburied. Therefore, we performed a meta-analysis pooling the results from several clinical trials to compare the outcome of using buried versus unburied K-wires. Potential academic articles were identified from the Cochrane Library, Medline (1966–2017.3), PubMed (1966–2017.3), Embase (1980–2017.3), ScienceDirect (1985–2017.3), and other databases. Gray studies were identified from the references of included literature reports. RevMan 5.1 was used to analyze the pooling of data. Nonrandomized controlled trials were included in this meta-analysis. There was a significant difference in the duration of wires in situ (MD = −13.28, 95% confidence interval: −16.42 to −10.14, P < .00001). No significant differences were found regarding infection, superficial infection, total complications, delayed union, or reoperation. Unburied K-wire fixation for treatment of lateral condyle distal humeral fractures in children does not increase the total infection rate, superficial infection, reoperation rate, or complications. However, unburied K-wire fixation is of benefit for early extraction and impartial cost savings.

Histological Features of the Distal Third Metacarpal Bone in Thoroughbred Racehorses, With and Without Lateral Condylar Fractures

A detailed histopathological study of the distal third metacarpal bone of Thoroughbred racehorses was undertaken to characterize lesions observed previously on magnetic resonance imaging (MRI). The bones were selected and grouped on the basis of MRI features. Representative sections in different planes were processed for histopathology. All lesions observed in the articular cartilage (AC) and subchondral bone (SCB) were recorded and graded with a scoring system, based partially on the Osteoarthritis Research Society International grading system. The scoring system included the severity of the lesion. Descriptive statistics and linear mixed effects models were performed. A positive correlation was observed between the severity of histopathological changes in the superficial and deeper osteochondral tissues, and between the number of race starts and AC score. Age was not correlated with AC or SCB score. A moderate variation in AC and SCB scores was observed between the groups; however, there were differences within individual bones. Bones with focal palmar necrosis (FPN) showed significant differences in the histological scoring of the AC compared with bones without FPN. Bones with incomplete fractures or larger areas of bone remodelling showed significant differences in SCB pathology when compared with bones with FPN. Haematoidin was detected in areas with excessive SCB and cancellous bone sclerosis and/or irregular bone density. This finding is suggestive of poor blood perfusion in these areas.

Infected gap nonunion of fractures proximal humerus in adolescent: an outcome of 12 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is little data about the risk factors, demographics, and prognosis for nonunions in children. Previous literature has reviewed time periods when contemporary techniques of internal fixation and management of open injuries had not been available. Infected gap nonunion of proximal 1/3 humerus in adolescent is not much reported the in literature. The purpose of our study was to evaluate the outcome of infected gap nonunion in 12 cases of adolescent treated by debridement and fibular graft and plating.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted between 2009 to 2015, 12 cases of Infected gap nonunion of fractures proximal humerus was included in our study. Each child was followed up minimum for 12 months. Although non unions in the pediatric population are rare, these data underscore the importance of careful evaluation and treatment of these fractures at risk for nonunion.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our series of 12 cases of infected nonunion of fracture humerus which were treated by bone grafting using fibula strut graft and plating resulted 99% union rate. The rate of union is depending on thorough debridement and fixation along with bone grafting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nonunion of pediatric fractures is a rare complication. Most studies on developing pediatric nonunions describe specific fractures that are particularly susceptible to nonunion and malunion, nonunion of humeral lateral condyle and open tibia fractures have received the most attention. Reports of nonunion among pediatric long bone fractures are rare, being either case reports or isolated entities in a larger series of predominantly adult fractures. Fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity.&lt;/p&gt;