Lateral Condyle Fractures Of Humerus Research Articles

Fixation of Lateral Condyle Humerus Fractures in Children by Terminally Threaded Screws

Fixation of Lateral Condyle Humerus Fractures in Children by Terminally Threaded Screws

K-wire versus screws in the fixation of lateral condyle fracture of humerus in pediatrics: a systematic review and meta-analysis

BackgroundLateral condyle fracture of the humerus is the second most common elbow fracture in children. Non-displaced lateral condyle fractures can often be managed with cast and conservative care, while reduction and fixation are often used to treat displaced lateral condyle fractures. Traditionally, K-wire fixation has been used for displaced lateral condyle fractures, but recently fixation using screws has been advocated in some studies. Therefore, we performed a meta-analysis to determine the difference in outcomes and complications between the two different fixation methods for the treatment of displaced lateral condyle fractures of the humerus in pediatric patients.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. PubMed, Embase, and Cochrane Library were used for study selection. Studies comparing K-wires and screw fixation in displaced lateral condyle fractures in pediatric patients were included. Clinical outcomes using the Hardacre criteria, infection, limitation of range of motion of the elbow, lateral condyle overgrowth, delayed union, nonunion, and avascular necrosis were compared. Data were analyzed using the meta package in R version 4.2.2, and random-effects or fixed-effects models were used according to heterogeneity.ResultsOne randomized controlled study and three retrospective cohort studies were included, with a total of 240 patients (K-wire:118, screw:122). The clinical outcome using the Hardacre criteria was not different between the groups (P = 0.54), but the risk of infection (risk ratio [RR] = 5.52, 95% CI: 1.42–21.48, P = 0.01) and limitation of range of motion (RR = 3.75, 95% CI: 1.54–9.18, P < 0.01) were significantly higher in the K-wire fixation group than in screw fixation group.ConclusionsThe use of screws for fixation after reduction in the treatment of lateral condyle fracture of the humerus in children decreases the risk of superficial infection and elbow stiffness compared with the use of K-wire. Although removal of the implant under general anesthesia is necessary, screw fixation can be considered in displaced lateral condyle fractures of the humerus in children.Trial registrationPROSPERO (CRD42023415643).

Cannulated Screw Versus Kirschner Wire Fixation Following Open Reduction of Lateral Condyle Fracture of Humerus

Background: Lateral condyle fracture (LCF) of the immature humerus is a transphyseal intra-articular injury. Where there is more than two millimeters of displacement, open reduction and internal fixation (ORIF) with anatomic reduction and secure fixation are essential to avoid complications. The aim of this study is to analyze the outcome of cannulated screw versus two divergent Kirschner wire (K-wire) fixation following open reduction of displaced lateral condyle fracture of humerus. Methods: A prospective randomized controlled trial was performed including 64 children in 2 treatment groups: Group-A (screw fixation) and Group-B (Kirschner wires). Primary outcome measures were radiological outcome and functional outcome. Secondary outcomes were stability of fixation and post-operative complications. Results: There was no significant difference in demographic characteristics of the children between two groups. Screw fixation was significantly superior in radiological outcome than K-wires. There was no significant difference in functional outcome or the stability of fixation between the two groups. Surgical site infection and lateral condylar overgrowth were significantly higher in the K-wire fixation group. Conclusion: Cannulated screw fixation is superior in radiological outcome with fewer complications than K-wire fixation in displaced LCF of humerus in children. But there was no significant difference in functional outcome and stability of fixation. Keywords: Cannulated screw, Kirschner wire, Lateral condyle fracture of Humerus, Children

Role of Percutaneous Screw Fixation in Children with Delayed Presentation and Nonunion of Lateral Condyle Humerus Fractures with Elbow Stiffness.

Delayed presentations and nonunion of lateral condyle of Humerus (LCH) fractures in children are common. It is recommended to gain elbow movements before placing single screw for late presenting LCH fractures. We examined the efficacy of a percutaneously placed screw in delayed presenting LCH fractures and LCH nonunion in children who presented with varying degree of elbow stiffness without waiting for improvement in elbow movements. Sixteen children with LCH fractures presenting after six weeks of fracture, without signs of union, and with frank nonunion were treated with percutaneous placement of the cancellous screw. There was a delay of 1.5 to18 months before presenting to us. The results were assessed by Dhillon criteria. All the patients at presentation had flexion deformity (avg 290) and restricted flexion ((avg 1000). Successful radiological union was achieved in fifteen patients. All the patients had full recovery of extension. Fifteen patient regained full flexion and one patient has only 100 flexion restriction (p value < 0.001). At the final follow-up, fifteen patients had excellent and one had a good overall Dhillon score. There was no clinically evident varus or valgus deformity. We could achieve union in a majority of the patients with delayed presentation and established nonunion of LCH fractures with simple percutaneous screw placement, thereby avoiding open surgery, big scar, bone grafting, and AVN of LCH. We did not wait for an improvement in elbow movements before screw fixation and still all our patients regained full elbow movements with improved Dhillon scores.

Translated article] Fractures of the lateral condyle of the humerus associated with elbow dislocation in children. A systematic review of the literature

BackgroundLateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for paediatric lateral condyle humerus fractures associated to elbow dislocation. MethodsA systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. ResultsThe initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2 out of 10 patients. ConclusionsCurrent evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.

Impacts of Fracture Types on Success Rate of Closed Reduction and Percutaneous Pinning in Pediatric Lateral Condyle Humerus Fractures Displaced >4 mm.

Closed reduction and percutaneous pinning (CRPP) is a promising treatment for pediatric lateral condyle humerus fractures (LCHFs) displaced >4 mm. However, few studies discussed roles of fracture types on success of CRPP in LCHFs. This study aimed to analyze the impacts of types of LCHFs displaced >4 mm on the success rate of CRPP. We retrospectively reviewed 66 consecutive pediatric LCHFs attempted CRPP at our center. Song, Milch, Jakob, and Weiss classification were used to classify LCHFs. The fracture gap ≤2 mm and step of articular surface ≤2 mm were deemed as a successful CRPP. Otherwise, open reduction and internal fixation (ORIF) would be performed. Different fracture types and preoperative displacement were analyzed for their roles on success rate of CRPP in treating LCHFs displaced >4 mm. Fifty patients met the inclusion criteria were finally included in this study. Results showed that Milch type II LCHFs had a higher success rate of CRPP than type I LCHFs (P=0.03, <0.05). Correlation was found between Milch types and success rate of CRPP displaced >4 mm. No difference was found between Song stage 4 and 5 LCHFs displaced >4 mm in success rate of CRPP (P=0.90, >0.05), also no difference was found in pre-operative displacement between CRPP group and ORIF group. Milch classification is more important than Song classification in the success rate of CRPP when treating LCHFs displaced >4 mm. Milch type II LCHFs are recommended to be treated with CRPP, while Milch type I LCHFs are recommended to be treated with ORIF. The current study confirm Song's initial report that closed reduction can be successful and should be attempted for fractures with such displacement rather than going directly to ORIF. Level III.

Buried vs. Exposed K-wire Fixation in Lateral Condyle Distal Humerus Fractures in Children

Introduction: Distal humerus lateral condyle fractures are common injuries in childhood and need effective treatment to prevent complications. Open reduction and internal fixation with Kirschner (K) wires is a proven, cost-effective and convenient technique for treating pediatric lateral condyle distal humeral fractures. K-wires may be buried beneath the skin or inserted through the skin with the wire ends exposed. There is no clear consensus as to whether K-wires should be buried or left exposed outside the skin. The aim of this study to compare the results and complications of divergent buried and non-buried K-wires in the treatment of lateral condyle fractures of the distal humerus. Methods: A study was conducted between March 2019 to August 2020 in 32 pediatric patients with lateral condyle fractures of distal humerus who were treated with open reduction with divergent k-wire fixation in our hospital. All patients under the age of 14 years presenting with lateral condyle humerus fractures with more than 2 mm displacement were included in the study. The exclusion criteria were open fractures, undisplaced fractures treated conservatively, and pathological fractures. Results: 32 patients under the age of 14 years were included in this study and were divided into two groups (Buried K-wire group and Exposed K-wire group) based on the treatment they received. Out of the 16 cases with exposed wires, 2 cases had superficial pin tract infection. And out of 16 cases with buried wires, 3 cases developed an infection, and 5 cases had skin erosion. However, no case of severe infection was seen. No cases of non-union were seen and all patients returned to preinjury function.

Fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Una revisión sistemática de la literatura

BackgroundLateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. MethodsA systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. ResultsThe initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients. ConclusionsCurrent evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.

To determine the differences in complications between buried versus unburied-k-wire fixation for pediatric lateral condyle fracture

Introduction: Operatively treated pediatric lateral humeral condyle fractures require longer period of in-situ k -wire fixation depending upon age, fracture configuration and mode of reduction. After fixation of lateral condyle fracture k-wires can be kept beneath or outside the skin. Aim: To determine the differences in complications between buried versus unburied K-wire fixation in pediatric lateral condyle humeral fractures. Patients and Methods: This prospective study was done in our centre on 50 operatively treated pediatric lateral condyle humeral fractures between January 2017 to Feb 2020. Results: This study included 50 patients among which 35 were males and 15 were females with average age of 7.5 (range 2-15 years). All patients were treated by ORIF and k-wire fixation. In buried group K-wire was kept for 7-12 weeks with average of 8 weeks and in unburied group K-wire was kept 5-9 weeks with average of 7 weeks. Complications like infection, scaring, nonunion, damage of physis due to infection and stiffness was more common in unburied group. Skin erosion, K-wire prominence and requirement of anesthesia was more in buried group. Conclusion: Our study found better results in operatively treated pediatric lateral condyle humerus fractures where k-wires kept beneath skin.

Comparative study between conservative treatment and percutaneous pinning of non displaced lateral condyle Humeral Fractures in young children

Objective: To compare the results of above-elbow cast conservative treatment and surgical percutaneous pinning of nondisplaced (grade1) lateral condyle humerus fractures in young children. Patients and Methods: This is a prospective study held on twenty patients at Samannoud general hospital, Gharbiae, Egypt. Ten patients underwent conservative treatment in the form of above-elbow cast, and ten patients underwent surgical treatment in the form of percutaneous pinning fixation. Results: One patient (10%) had a secondary displacement in the conservative treatment group after a week and needed surgical intervention. No other complications were reported in this group. One patient (10%) had a mild pin tract infection in the pinning group, which resolved after removal. All patients in the study restored elbow full range of motion one week from plaster removal. Sixteen patients (6 conservative and ten pinnings) had overgrowth after the procedure with no statistical difference between the two groups, that was not also clinically evident. No significant difference in any outcome was detected between the groups.Conclusion: Lateral condyle humerus fractures need proper radiological evaluation on initial presentation after trauma and close follow-up. The present study demonstrated no significant difference in outcomes on the short term scale between conservative versus surgical treatment for grade 1 fractures, except for the possible re-displacement (10%) comparable to the literature. Patients’ parents/guardians would be offered conservative treatment as a first option if good compliance and close follow-up in the first few weeks are possible, which would avoid the potential complications of anaesthetics and surgical risks.

Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study.

Buried Kirschner's wires (K-wires) following internal fixation of paediatric Lateral condyle fracture of humerus allow them to hold the bone until radiological consolidation but requires another surgical procedure for implant removal. Exposed wires need meticulous pin tract care, earlier implant removal and may carry a higher risk of infection. The objective of this study was to compare the outcomes of buried versus exposed K-wires for these fractures. This prospective comparative(nonrandomised) study was conducted from July 2016 to April 2020 at a tertiary care level I trauma centre on 80 children, <12 years of age, divided into group 1(n = 40), where K-wires were left exposed, and group 2 (n = 40), where K-wires were buried. Functional outcome and complications were compared between the two groups with at least 3 months follow-up. Infection rate was significantly lower in buried K-wire group with 7 patients (17.5%) compared to 15 (37.5%) in exposed group, P = 0.045. Four out of those 15 patients needed debridement suggesting that exposed K-wires carry a higher risk of bone infection and subsequent morbidities. There was no significant difference in union time, range of motion (mean flexion 135.3° in exposed vs. 132.5° in buried, P = 0.988), carrying angle (8.5° vs. 8.6°, P = 0.981), or lateral condyle hypertrophy; 12 (30%) vs. 9 (22.5%), P = 0.446. Skin pigmentation was more in the exposed group; 13 (32.5%) vs. 10 (25%), P = 0.459. We recommend that K-wires should be buried subcutaneously, particularly when meticulous pin tract care is doubtful.

Management of Acute Lateral Condyle Fractures of Humerus

Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature. Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection. Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function. Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.

Neglected Lateral condyle Humerus Fractures: Current Concepts and Practices

Neglected lateral condyle fractures present varied and difficult challenges to the treating orthopaedic surgeon. They have the potential to cause long term problems like deformities, stiffness, instability and tardy ulnar nerve palsy. The treatment of lateral condyle non-unions depend on the presence or absence of deformity, the duration of non-union, skeletal maturity of the child and the presence or absence of ulnar nerve palsy. Accordingly the treatment ranges from conservative management in neglected fractures with no deformity and no ulnar nerve palsy at one end, Open/mini-open or closed in-situ fixation for established non-unions with instability and corrective osteotomy with fixation of non-union and ulnar nerve transposition at the other end. In this article, the authors have endeavoured to go through the various aspects of clinical presentations and treatment modalities for this difficult fracture. Keywords: Neglected lateral condyle fractures, Cubitus valgus, Tardy ulnar nerve palsy, Instability.

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

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

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.

Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children

Introduction: This study compares the outcome of two treatment modalities of fixing neglected lateral condyle fracture of humerus in children in terms of clinical and radiological outcomes.Materials and Methods: All patients presenting to our institution were screened for eligibility by clinico-radiological evaluation. Patients were randomized into two groups i.e. Cancellous screw (CS) fixation (group I) and K wire fixation (group II). Patients were treated by open reduction and internal fixation using CS or K wires of appropriate size accordingly. (21 patients in group I and 19 patients in group II). Bone graft was used in all patients to promote osteosynthesis. Average follow up of patients was 18 months (range 11-22 months). Final outcome was measured in terms of clinicoradiological union, immobilization time, loss of reduction, gain in range of motion and functional outcome measured by Liverpool elbow score.Result: 21 patients were in group I (CS) and 19 patients were in group II (K wire). Mean age for group I and II was 7.9 and 7.5 years. Mean delay in presentation for group I and II was 14.9 and 13.2 weeks. Mean gain in range of motion (at final follow up as compared preoperatively) for group I and II was 23.5 and 17.8. Mean duration of immobilization for group I and II was 11.3 and 9.6 weeks. Mean LES score was 8.7 and 8.3 in group I and II. Union was seen in 37 cases. Three patients had pre mature physeal closure. Pin tract infection was seen in 4 patients in group II which healed by dressing and antibiotics. No patient had ulnar nerve palsy. Conclusion: Both techniques provide stable fixation, union and good functional outcome and there was no difference in the LES, however less immobilization and improvement in range of motion was seen in Group I (CS)

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.&#x0D; 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.&#x0D; 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.+&#x0D; Conclusion: Outcome was better in early cases by operative treatment but late cases up to 12 weeks should be treated by operation.&#x0D; 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.

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.

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.