Lateral Condyle Fractures Research Articles

Lateral humeral condyle fractures: diagnosis, classification, management and complications

INTRODUCTION: Lateral condyle fractures (LCF) of the distal humerus are one of the more common skeletal injuries in the pediatric population. The mean age of patients with these fractures is 6 years. In the majority of the cases, the diagnosis is based on clinical and radiographic examination. The most recent classifcation divides these fractures according to degree of displacement and stability. EVIDENCE ACQUISITION: A literature search was performed using Pubmed and Scopus database, until June 2020. Inclusion criteria were studies regarding lateral humeral condyle fractures in pediatric patients. Case reports were excluded. EVIDENCE SYNTHESIS: Most of the studies in literature are retrospective with contrasting opinions and conclusions on diagnosis, classifcation and management. CONCLUSIONS: Regarding the diagnosis and classifcation, the stability of the fracture remains in some cases diffcult to ascertain and MRI can be helpful in identifying the integrity of the articular cartilage and hence fracture stability. Displaced or unstable fractures are preferably treated by closed reduction and percutaneous pinning, while fractures that have rotation of the condylar fragment need to be treated surgically. ORIF can be performed by using different approaches, and the methods of fxation are K-wires or screws. The main factors associated with long-term results are quality of reduction and timing of treatment. The most serious complications are cubitus varus, nonunion, AVN of the condylar fragment and ulnar nerve palsy.

Study of various modalities of treatment of internal fixation of tibial condylar fracture-schatzkers type v and type VI

Fractures of the tibial plateau usually result from high energy trauma. Fractures of the tibial plateau change the knee kinematics, alter joint stability, and cause joint incongruity. Fractures range from simple lateral condyle fractures to severe comminuted metaphyseal fractures. Various surgical modalities like open reduction internal fixation with cannulated Screw fixation, Condylar plate with or without bone graft, AO/ASIF Buttress plate (T/L) with or without bone graft, Proximal tibial locking plate have been practiced. To study the functional outcomes of various modalities of treatment of internal fixation of tibial condylar fractures schatzkers type V and type V1. To find out the basis of selecting the mode of treatment of tibial condylar fractures to bring out the best functional results. 35 patients of age group 18-70 yrs who presented with X-ray based Schatzker Type V and VI proximal tibia fractures were selected for the study. All the patients underwent Open Reduction and Internal Fixation with locking compression plating. The functional outcomes were assessed using knee society score. Complications were observed and treated accordingly with an average follow-up of 12 months. It was observed that the mean duration of the union was 14-16 weeks. Most of the patients (19) showed excellent results with a good range of motion of 122⁰. The combination of dual approaches with dual fixation and with fixed angle locking plates is a safe and effective way to have direct reduction and satisfactory fixation for complex tibial plateau fractures.

Does an elbow arthrogram change management after closed reduction of mildly displaced lateral condyle fractures in children?

Does an elbow arthrogram change management after closed reduction of mildly displaced lateral condyle fractures in children?

Characteristics of Cubitus Varus Deformity after Lateral Condylar Fracture of the Humerus.

Background: Lateral humeral condylar fractures often heal with some residual elbow deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. Methods: Between 2008 and 2016, we followed up 80 mild fractures of the lateral humeral condyle for more than a year. Thirty fractures were treated by open reduction and internal fixation (ORIF) with Kirschner wires. Fifty cases were treated with a long arm splint for 3 weeks (Fig. 1). The average age of the patients at the time of the injury was 5.5 years. The humerus-elbow-wrist angle (HEWA), Baumann's angle (BA), and tilting angle (TA) were measured on the radiographs. The active range of motion (ROM) was clinically assessed at unaffected and affected sides at the final follow-up. Results: No significant differences were detected between the sides about TA or ROM at the final follow-up. However, HEWA/ BA showed more significant loss of correction. There were significant differences in BA at the affected side between the ORIF and splint groups. Conclusions: Cubitus varus deformity after lateral humeral condylar fracture is not accompanied by a change in TA or ROM, unlike the deformity after supracondylar or distal epiphyseal fracture of the humerus (Fig. 2). Operative treatment to precisely correct and fix the lateral condylar fracture still retained some cubitus varus deformity, although it might lessen or prevent the deformity when compared to conservative treatment with a splint.

Comparison of closed and open reduction internal fixation of acutely displaced unstable lateral humeral condylar fractures in children: a prospective cohort study

Background: Lateral humeral condylar fractures in children are considered the second most common type of fractures in pediatric elbows after supracondylar fracture. Conservative treatment of these types of fracture usually fails. Open reduction and internal fixation of these types of fractures has been the treatment of choice with regard to anatomical reduction and stable internal fixation. Complications of open reduction range from mild complications, such as scars of the skin incision, to severe, such as avascular necrosis of the lateral condyle. Closed reduction and percutaneous fixation of the fracture may give the same results as open reduction with regard to reduction and healing of the fracture but without the complications of open reduction. Methods: This prospective interventional study was conducted in 60 patients who had lateral humeral condylar fractures. Patients were grouped into two equal groups: one group was managed by closed reduction and internal fixation (CRIF), and the second group was managed by open reduction and internal fixation (ORIF). Results: The two groups were compared after the operation and 1-year follow-up. There was no difference between the two groups with regard to fracture healing and complications, with the exception of complications of wound healing and skin scarring after open reduction. Conclusions: Closed reduction and percutaneous pinning of lateral humeral condylar fractures gave the same results in bone healing without the complications of skin-incision healing that were found in open reduction. Level of Evidence: Level III.

Trash Lesions Around the Elbow: A Review of Approach to Diagnosis and Management.

TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.

Radiographic technique to improve diagnosis of sagittal axial sesamoid fracture in racing Thoroughbreds with lateral condylar fracture

SummaryThe current study identified 124 lateral condylar fractures of the distal metacarpus or metatarsus over a 6‐year period. Thirty of 124 lateral condylar fractures were classified as displaced. Eight of 30 displaced lateral condylar fractures and 1/86 incomplete lateral condylar fractures had concurrent sagittal axial fracture of the lateral proximal sesamoid bone. A 20‐degree DMPLO view is the most sensitive radiographic projection to identify sagittal axial fracture of the lateral proximal sesamoid bone. A flexed 20‐degree DMPLO projection demonstrates displacement of complete sagittal axial sesamoid fractures. Radiographic identification of axial sesamoid fracture is critical to provide the most accurate prognosis for return to racing. Arthroscopic assessment of the axial sesamoid fracture and cartilage injury on the lateral proximal sesamoid bone, as well as post‐operative progression, are described in four surgical cases.

Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children.

It is difficult for surgeons to successfully perform closed reduction and percutaneous pinning on displaced and rotated lateral condylar humeral fractures in children. This study aimed to introduce an ultrasound-assisted closed reduction and percutaneous pinning technique and determine its usefulness in the treatment of displaced and rotated lateral condylar humeral fractures in children. Between 2013 and 2018, 42 of 44 displaced and rotated pediatric lateral humeral condylar fractures were successfully treated with ultrasound-assisted closed reduction and percutaneous pinning. All surgical procedures were performed by 1 senior surgeon. Demographic and clinical data including age, sex, affected side, time from injury to reduction, operative time, and number of intraoperative radiographs (without fluoroscopy) were analyzed. Postoperative data were evaluated in terms of Kirschner wire in situ duration, follow-up duration, range of motion, carrying angle, cosmetic result, and complications. The average operative time was 67 minutes from 2013 to 2015 and 51 minutes from 2016 to 2018. All 42 patients who successfully underwent ultrasound-assisted closed reduction were followed up for >3 months, and 31 of 42 patients were followed up for >1 year. Among these 31 patients, the range-of-motion outcomes were excellent in 25 and good in 6. The carrying angle outcomes were excellent in 28 patients and good in 3. Two instances of wire infection, 9 instances of granulation tissue hyperplasia, and 23 instances of lateral spur formation occurred. No nonunion, avascular necrosis, or postoperative nerve issues were identified. The surgical technique of ultrasound-assisted closed reduction and percutaneous pinning presented in this study can effectively help surgeons reduce displaced and rotated lateral condylar humeral fractures in children to avoid some open reductions and achieve satisfactory outcomes.

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

<p><strong>Background:</strong> 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.</p><p><strong>Methods:</strong> 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.</p><p><strong>Results:</strong> 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</p><p><strong>Conclusions:</strong> The displaced fractures (displacement over 2 mm) can be treated successfully by open reduction and K-wires or screw fixation with excellent results.</p><p> </p>

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.

Understanding the susceptibility to lateral condyle fracture by analyzing unaffected Baumann's angle in children with distal humeral fracture

BackgroundPrevious studies have shown that posttraumatic cubitus varus deformity in children is somehow related to subsequent humeral lateral condyle fracture. Moreover, we had previously encountered an exactly similar case. In this study, we aim to understand whether there is a morphological difference between pediatric supracondylar and lateral condyle fracture of the humerus by comparing Baumann's angle of the unaffected elbow. MethodsWe conducted a retrospective evaluation of 40 cases of supracondylar fractures (36 boys, 4 girls) and 20 cases of lateral condyle fractures (16 boys, 4 girls) at a single facility between January 2014 and December 2018. The unaffected Baumann's angles and lateral capitellohumeral angles of both groups were measured by two orthopedic surgeons and analyzed using Welch's t-test. The effect size was also calculated using Cohen's d, and intraclass correlation coefficients were applied for intra-rater and inter-rater reliability. ResultsThe average age of patients in the supracondylar fracture group was 6.78 years and that in the lateral condyle fracture group was 5.70 years. No significant differences were observed between gender and fracture type, between laterality and fracture type, and in the lateral capitellohumeral angles between the groups. Baumann's angle was significantly less in the lateral condyle fracture group (17.27° ± 4.68°) than in the supracondylar fracture group (20.28° ± 3.10°) as analyzed by Welch's t-test (p = 0.015). The effect size was 0.76. Each of the intra-rater reliabilities were 0.97 and 0.96, whereas the inter-rater reliability was 0.75. ConclusionsA significant morphological difference was found between the supracondylar fracture group and the lateral condyle fracture group. The loss of Baumann's angle which tends to occur after the healing of supracondylar fracture may increase the susceptibility to lateral condyle fracture. Orthopedic surgeons should repair and fix supracondylar fractures appropriately to avoid an ipsilateral second fracture, such as lateral condyle fracture.

A prospective study of malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy Supracondylar humeral fractures are most common elbow fractures in children. The most common complication among all is malunion leading to cubitus varus deformity.Lateral closing wedge osteotomy is the easiest, the safest, and inherently the most stable osteotomy to correct the varus deformity with minimal correction of hyperextension. Aim: To examine the malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy with cubitus varus. Material and Methods: A total of 25 children of malunited supracondylar fracture of humerus were treated by lateral closed wedge osteotomy fixed by two screws and figure of eight tension band wire.The fixation was supplemented with one lateral K-wire. Post-operatively, according to Oppenheim’s criteria patient were evaluated and parents and patient’s satisfaction with final appearance and function of the limb was taken into consideration. Results: According to the Oppenheim et al. criteria, is similar to our study, excellent outcome was noted in 18(72%) cases, good outcome in 5(20%) cases and poor outcome in 2(8%) cases. 18(92%) patients/parentswere satisfied with the final outcome. Conclusion: Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity with less complications.

Severe tardy ulnar nerve palsy due to cubitus valgus deformity: Use of intramuscular anterior transposition

Tardy ulnar nerve palsy is a frequent late complication of post-traumatic cubitus valgus deformity arising due to nonunion lateral condyle humerus fracture. We present a case of a 30 year old homemaker who came with features of tardy ulnar nerve palsy (McGowan grade III) with difficulty in activities of daily living and reduced grip strength. Clinical examination revealed atrophy of hand muscles, claw hand deformity and other features suggestive of ulnar neuropathy. X-rays and CT scan confirmed the diagnosis as fracture lateral condyle humerus nonunion. Surgical intervention in the form of anterior intramuscular transfer of ulnar nerve with neurolysis without addressal of nonunion site was performed. The patient showed complete recovery of sensory and motor symptoms at six months post-op. Anterior transposition of ulnar nerve is a safe and reliable procedure which provides good functional outcomes in cases of tardy ulnar nerve palsy with low morbidity.

Characteristics of Osteochondral Fractures Caused by Patellar Dislocation.

Background:Literature describing the anatomic characteristics of osteochondral fractures (OCFs) in the knee joint after patellar dislocation is scarce.Purpose:To describe the patterns of OCFs in the knee joint after acute or recurrent patellar dislocation in a sample of patients from 2 orthopaedic trauma centers.Study Design:Case series; Level of evidence, 4.Methods:In this multicenter study, all patients who had International Classification of Diseases, 10th Revision, diagnostic codes S83.0 and M22.0 between 2012 and 2018 were screened. Of the 2181 patients with clinically diagnosed patellar dislocation, 1189 had undergone magnetic resonance imaging (MRI). Patients with diagnosed patellar dislocation and osteochondral fragment verified on MRI scans were included. Demographic and clinical data were collected from electronic patient records. OCF location and size were assessed from MRI scans. Results were further compared in subgroups by sex, skeletal maturity, and primary versus recurrent patellar dislocation.Results:An OCF was detected in 134 patients with injured knees, all of whom were included in the final analysis. It occurred in the patella in 63% of patients, in the lateral femoral condyle in 34%, and in both locations in 3%. The median OCF size was 146 mm2 (interquartile range, 105-262 mm2). There was no statistically significant difference in OCF size between patellar and lateral femoral condyle fractures. Patellar OCFs were more frequent in female than male patients (P = .009) and were larger after primary than recurrent dislocation (P = .040).Conclusion:OCFs were mainly located in the medial facet of the patella and in the lateral femoral condyle, with these locations accounting for approximately two-thirds and one-third of all OCFs, respectively. Proportion of patellar OCF was higher in female than in male. Patellar OCFs may be larger after primary than recurrent dislocation.

Functional and Radiological Outcome in Delayed Presenting Closed Displaced Lateral Condyle Fracture of Humerus in Children.

This prospective cohort study was conducted from July 2013 to May 2019. The functional and radiological outcome in displaced, neglected fracture of lateral condyle of the humerus treated with open reduction and internal fixation (ORIF) with Kirschner wire was assessed. The sample size was 44 children aged between 2 to 15 years Milch type I and II displaced lateral condyle of humerus fracture, four weeks and older were included. Carrying angle and infection was assessed clinically. Union and elbow functions were evaluated radiologically using the Mayo elbow score. The mean age of the children was 6.82 ± 2.83 years. Fracture was Milch type I in 11 (25%), and type II in 33 (75%). Pre- and post-operatively, Mayo elbow score was 3.63 ± 0.57 and 1.56 ± 0.50, respectively. Good to excellent functional outcome, and union was observed in delayed presenting lateral condyle of humerus fractures. Key Words: Lateral condyle humerus, Children, Delayed presentation, Mayo elbow score.

Delayed Union of Lateral Condyle Fracture of Humerus : a case report

Delayed Union of Lateral Condyle Fracture of Humerus : a case report

Open reduction and internal fixation with k-wire of lateral condylar fracture in children

Open reduction and internal fixation with k-wire of lateral condylar fracture in children

Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants

To evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants. The clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used. None of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation ( t=22.670， P=0.000； t=11.910， P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%. Elbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.

Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

<p><strong>Background:</strong> Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.</p><p><strong>Methods:</strong> A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020. A total number of 37 subjects were included in the study.</p><p><strong>Results:</strong> Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.</p><p><strong>Conclusions: </strong>Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort.</p>

Fixation of fracture capitellum humerus

Fixation of fracture capitellum humerus - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/2395-1362.2018.0025, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg