Lateral Condyle Fractures Of Humerus Research Articles

Outcomes for late presenting lateral condyle fractures of the humerus in children: A case series

BackgroundFractures of lateral condyle of humerus are very common in children. While the management of acute displaced and rotated lateral condyle fracture of humerus with early open reduction and internal fixation yields good results, the results of late treatment are less clear. We conducted this study to analyse the results of operative treatment of late presenting fractures and see if it is dependent on the patient's age, fracture type, or the time until treatment. Materials & methodsA retrospective study of 40 patients with a symptomatic lateral condyle fracture beyond 3 weeks, who underwent open reduction and internal fixation between January 2002 and December 2011, was conducted. Fractures were described as per Jakob's classification. Patients radiographs were evaluated, and clinical evaluation was done with Mayo elbow scoring and Dhillon scoring system as well as range of motion. ResultsThirty-nine fractures united with average time of 7.8 weeks except one who had previous surgery done for the fracture and developed avascular necrosis. The average Mayo score was 93 and average Dhillon score was 7.6. The average improvement in the arc of motion was 40.32° (77.3–117.6°). Younger age and shorter time to operation had a statistically significant but weak effect on outcomes. ConclusionsFunctional outcomes of fractures managed surgically revealed good results, even in the fractures presenting more than 12 weeks after injury. Families with children presenting late should be offered ORIF to improve function and decrease symptoms.

Delayed Unions and Functional Outcomes of Pediatric Lateral Condyle Humerus Fractures: a mProspective Study

Purpose: The purpose of our study was to prospectively study outcomes in lateral condyle humerus fractures (LCHFs) using validated outcome measures. Methods A prospective enrollment of consecutive children with LCHFs treated at one institution from 2013 to 2016 was performed. Fractures were classified based on fracture displacement (I: 4mm). A delayed union is defined as casting for persistent fracture …

Delayed Unions and Functional Outcomes of Pediatric Lateral Condyle Humerus Fractures: a mProspective Study

Delayed Unions and Functional Outcomes of Pediatric Lateral Condyle Humerus Fractures: a mProspective Study

What's New in Pediatric Orthopaedic Trauma: The Upper Extremity.

Upper extremity fractures are the most common fractures in children. Many high-quality studies have been reported regarding operative and nonoperative treatment of different upper extremity fractures in children. This review will summarize the literature on 4 major upper extremity fractures in children over the past 5 years. PubMed and Embase databases were queried for publications in the English language on supracondylar humerus (SCH) fractures, lateral humeral condyle fractures, medial epicondyle fractures, and clavicle fractures from January 1, 2013 until November 1, 2018. Papers believed to yield significant findings to our profession were included in this review. A total of 1150 studies were related to the search terms, and after cursory assessment, the authors elected to fully review 30 papers for this publication: 12 related to SCH fractures, 10 related to lateral condyle humerus fractures, 3 related to medial epicondyle humerus fractures, and 5 involving clavicle fractures. The level of evidence for these studies was either level III or IV. SCH fractures are increasingly being treated at trauma centers or pediatric hospitals in the United States. The rate of open reduction in this fracture type is decreasing overall, but the flexion type SCH fractures (especially in the setting of ulnar nerve injury) continue to be at increased risk of requiring open reduction. There has been a paradigm shift in the treatment of lateral condyle humerus fractures, wherein authors have demonstrated successful management with closed reduction and percutaneous pinning when an adjunct arthrogram is performed demonstrating articular congruity. More studies are needed to find the optimal treatment for displaced medial epicondyle and clavicle fractures in adolescents, as results to date do not necessarily mirror those seen in the adult population. Level IV.

Arthrography in treatment of humeral condyle fractures with displacement of less than 2 mm in children

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children. Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics, Honghui Hospital, Xi'an Jiaotong University College of Medicine from April 2015 to December 2016. They were 14 boys and 7 girls, aged from 5 to 12 years (average, 8.6 years). Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm. Of them, 2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A), 11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B), and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C). The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system. Results All the 21 children were followed up from 9 to 23 months (average, 16 months). The fracture union time ranged from 8 to 10 weeks (average, 9 weeks) for groups A and B and from 11 to 13 weeks (average, 12 weeks) for group C. By the Dhillon scores at final follow-ups, the therapeutic efficacy was evaluated as excellent in one and as good in one in group A, as excellent in 8 cases, as good in 2 cases and as fair in one in group B, and as excellent in 6 cases, as good in one and as fair in one in group C. No early closure of epiphysis, osteonecrosis or fishtail deformity was found in either group A or group B; one case of partial limitation of elbow flexion or extension, one case of fishtail deformity and one case of femoral head necrosis were observed in group C. No infection or skin necrosis was found in any of the 3 groups. Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable, it can make up for the insufficiency of X-rays in judging integrity of the articular surface. In combination with closed reduction, percutaneous puncture or open reduction and internal fixation, intraoperative arthrography can contribute to an increased rate of successful surgery, and reduced complications due to redisplacement. Key words: Elbow joint; Arthrography; Child; Lateral condylar fracture

Measurement Reliability in Pediatric Lateral Condyle Fractures of the Humerus.

Lateral condyle fractures of the distal humerus are the second most common pediatric elbow fracture. A difference of 1 or 2 mm in fracture displacement measurement may change the operative or nonoperative management of a minimally displaced fracture. The goal of this study was to determine the interobserver and intraobserver agreement in the measurements of displacement of lateral condyle fractures of the humerus. A retrospective radiographic review of 60 patients was performed by 3 reviewers. Fracture displacement was measured in millimeters on all radiographic projections and repeated by a single author 1 month later. Intraclass correlation coefficients (ICC) were calculated for intraobserver and interobserver agreement. We then calculated the percentage of measurements that differed by >1 or 2 mm. Analysis was performed on the entire cohort of displaced fractures and again separately for a cohort of minimally displaced fractures (defined as <5 mm). The combined ICC for intraobserver reliability across all radiographic projections was 0.96 (range, 0.952 to 0.977), but there was disagreement between a single reviewer's own measurements 17.3% of the time. Within the cohort of fractures displaced <5 mL, this intrarater disagreement (>2 mm) dropped to 4%. Interobserver reliability was also high with an ICC of 0.90 (range, 0.861 to 0.924). Within the minimally displaced cohort (<5 mm), the interrater disagreement was 6.6% when using a 2 mm cutoff and 22.2% when using a 1 mm cutoff. Intraobserver and interobserver reliability are high when measuring lateral condyle fractures and the percent of clinical disagreement is low when measuring minimally displaced fractures for which treatment depends on measuring to the millimeter. The internal oblique projection is the most reliable view for measuring lateral condyle fracture displacement, whereas the external oblique view offers little in terms of reliability. This study may be used as a platform for further research, verifying that reliable measurements of lateral humeral condyle fracture displacement can be obtained within 1 to 2 mm from adequate plain films. Level III.

Management of Neglected Lateral Condyle Fracture of Humerus: A Comparison between Two Modalities of Fixation.

Background:Implant for fixation of neglected fracture lateral condyle humerus remains an issue of controversy. This study compares the clinical and radiological outcome of fixation with Kirschner wire (K-wire) and with cancellous screw (CS) in neglected fracture lateral condyle humerus.Materials and Methods:42 patients of neglected lateral condyle humerus fracture, treated either by open reduction and internal fixation (ORIF) with K-wire or ORIF with CS were included in study. The comparisons were made in term of slab immobilization time, union time, improved range of motion (ROM), final achieved carrying angle, and functional outcome measured by Liverpool Elbow Score (LES).Results:There were 22 patients in Group I with mean age 7.8 years and 20 patients in Group II with mean age 7.3 years. Mean delay in presentation was 12.9 versus 15.6 weeks (P > 0.05). Mean followup was 26.9 versus 26.7 months. Mean duration of immobilization was 11.6 versus 9.4 weeks (P < 0.001). Improved carrying angle was 6.8° versus 9.7° (P < 0.05). Mean gain in ROM was 17.7° versus 27.5° (P < 0.05). Mean LES was 8.15 versus 8.18 (P > 0.05). Premature closure of physis was observed in two patients. Pin tract infection was seen in three of Group I (P > 0.05).Conclusion:There was no difference in LES, irrespective of implant used. Screw was better in terms of duration of slab, improvement in carrying angle and ROM.

Early Versus Late Removal of Internally Fixated Kirschner's Wires for Displaced Lateral Condyle Fracture of Humerus in Children.

Introduction:Lateral condyle fracture of the distal humerus is the second most common paediatric elbow fracture. Unstable, rotated and displaced (>2 mm) fractures are managed with open reduction and internal fixation with Kirschner’s wires or screws. Debate persists as for how long the Kirschner’s wires should be placed in situ after internal fixation. We aimed to compare the functional and radiological outcome after early versus late removal of internally fixated Kirschner’s wires for displaced lateral condyle fracture of distal humerus.Methods:Children that underwent early (3-4 weeks) or late (5-7 weeks) removal of Kirschner’s wire after open reduction and internal fixation for displaced lateral condyle fracture of humerus were observed for a period of minimum 6 months. Time to radiological union, carrying angle, range of motion was assessed and compared between early and late group. Functional outcome was compared using the Dhillon scoring system.Results:We report the outcome of 40 cases (20 cases in each early and late group). Radiological union was achieved in all the cases of both group at 12 weeks follow up. The mean loss of carrying angle was statistically insignificant (p = 0.394) between the early and late group. There was no significant difference between the early and late group in relation to arc of motion at 12 weeks (p=0.724) and 6 months (p=0.638) follow up. Using the Dhillon scoring system, there was 100% excellent Dhillon score in early group, 80% excellent and 20% good Dhillon score in late group. Functional outcome was statistically insignificant between the two groups (p = 0.106)Conclusion:Early removal of internally fixated K-wires for displaced lateral condyle fracture of humerus in children showed similar radiological and functional results to late removal.

Pining Fixation Versus Canulated Screw with Open Reduction of Pediatric Lateral Condyle Humerus Fractures

Good results have been described for lateral condyle Fractures pediatrics treated by open reduction and fixation usingKirschner wires or screws.We, in our level III retrospective comparison clinical research study, retrospectively reviewed 20patients (10 K-wire, 10 screw fixation; average age 5.6 years, average follow-up 6.8 months). The clinical outcomes wereevaluated according to the criteria of Hardacre et al. There was no statistically significant difference in clinical outcomebetween these two groups. Two patients developed skin infection around K-wires, while no infection occurred in fracture withscrews. An obvious lateral prominence occurred in one patient with K-wires and none with screws. One patient with K-wiresand one patient with screws had a lack of 15° of extension of the elbow compared with the other side. With K-wires therewere two nonunions (average time to union 9.6 weeks). With screws, one nonunions (average of 6.8 weeks). Both K-wires andcannulated screw fixation are effective in treatment for lateral humeral condyle fracture. K-wires can pass through the ossificnucleus of capitulum without damaging it, but a longer period of external fixation and local skin care will be required. Screwfixation patients spent fewer days in a cast and had agreater range of motion at the last follow-up. Screw fixation is associatedwith fewer nonunions and faster time to union, but a secondary procedure for removal is required .

Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children. We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria. We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united. Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.

"Screw fixation for Lateral Condylar Fracture of Humerus in Children"

"Screw fixation for Lateral Condylar Fracture of Humerus in Children"

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

Clinical Results of Lateral Condyle Fractures of Humerus in Children

Clinical Results of Lateral Condyle Fractures of Humerus in Children

Outcomes of K-Wire Removal at 3 Weeks in Lateral Condyle Fractures of Humerus in Children

Outcomes of K-Wire Removal at 3 Weeks in Lateral Condyle Fractures of Humerus in Children

Rate and Risk Factors for Delayed Healing Following Surgical Treatment of Lateral Condyle Humerus Fractures in Children.

Lateral condyle humerus fracture nonunion after surgical fixation has been reported to be <1%. The purpose of this study was to evaluate the rate and risk factors for delayed healing of pediatric lateral condyle fractures after surgical fixation. Retrospective study of all operatively treated lateral condyle fractures at a single institution from 2006 to 2013 was performed. Radiographic evaluation included: measured fracture displacement at both presentation and after surgical fixation, fracture classification, and multiple parameters of pin configuration. Patients who had delayed healing were defined as those not healed by the eighth week of follow-up and were compared with those fractures that healed in <8 weeks to identify risk factors associated with delayed healing. Purposeful selection was utilized to identify factors for entry into a multivariate binary logistic regression model. A total of 210 children were evaluated. Mean follow-up was 25 weeks (4 wk to 5 y). Distribution of Weiss classification was as follows: type 1, 8 (4%); type 2, 61 (29%); and type 3, 141 (67%). There were 33 (16%) delayed unions and 7 of these (3% of the entire cohort) required further surgery to achieve healing. Weiss classification, intraoperative fluoroscopy time, and intraoperative displacement after fixation met criteria for entry into the regression. While Weiss classification did not remain significant within the model, its removal resulted in a 30% change in the parameter estimate for intraoperative fluoroscopy time. For each second increase in fluoroscopy time, there is a 3% increase in the risk of delayed healing. Patients with >1 mm displacement of the lateral cortex after fixation had an increased risk of delayed healing (OR=4.78, P=0.007). Delayed union of lateral condyle fractures is a matter of concern, and the rate of secondary surgery to achieve healing appears to be higher than previously reported. Risks for delayed healing include amount of residual displacement after reduction and the difficulty in attaining that reduction, as defined by fluoroscopy time. Level IV-therapeutic study, case series.

Outcome of paediatric lateral condyle humerus fractures treated operatively

Background: Paediatric lateral humeral condyle fractures account for 17 % of the distal humeral fractures. Displaced and rotated fractures require appropriate reduction and stabilisation. Aims: The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). Material and methods: We prospectively reviewed 30 children operated for lateral humeral condyle fractures at a single institution over a period of 3 years. Age distribution, fracture classification, mode of fixation, time to union, complications and final outcomes at the latest follow-up were reviewed. Results: Total 30 patients of lateral condyle fractures were identified in which there were 18 male and 12 female patients. Average age was 8.07 years. 10 were Milch type II and 20 Milch type I. According to the Jacob’s classification, 05 were type I and 17 were type II and 08 were type III. All fractures were treated with open reduction and fixation with K-wires except one which was treated with CRIF. Average time to radiological union was 6.1 weeks. Radiological hypertrophy of the lateral condyle was present in 4 cases (13.33 %). 3 patients developed a pseudo-cubitus varus deformity. Conclusion: Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Key words: Paediatric lateral condyle fractures, ORIF, Radiological union

Open reduction and Kirschner wire fixation for treatment of humeral lateral condylar fractures in children

Objective To investigate the early diagnosis and treatment strategies of lateral condylar fractures of humerus in children.Methods From July 2010 to July 2012,15 patients with humeral lateral condyle fractures were treated with open reduction and internal fixation with Kirschner wires in our hospital.The treatment outcomes were assessed using Flynn functional criteria and radiographical assessment of osteoarthritis or heterotopic ossification around the elbow.Results All the patients were follow-up for a mean time of 18.5 months (range,13 to 27 months).Bony healing was achieved in all the patients,within an average of 2.0 months (range,1.4 to 2.7 months).No nonunion and delayed union were observed in X-ray films.According to Flynn criteria,the results were excellent in 13 cases and good in 2 cases.Conclusion Displaced humerus lateral condyle fracture is easy to be misdiagnosed or missed because ossification occurs late in children.The fracture therefore doesn't show on X-rays.Early diagnosis is important in order to reduce various deformities and complications.Open reduction and crossed Kirschner wire fixation can lead to satisfactory reduction and firm fixation with fewer complications.At present it is an ideal method for treatment of lateral condylar fracture of humerus in children. Key words: Child; Humerus fractures; Early diagnosis; Lateral condyle

Management of neglected lateral condyle fractures of humerus in children: A retrospective study

Background:Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results.Materials and Methods:Twenty two pediatric (≤12 years) patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically) and elbow function (Liverpool Elbow Score, LES) was assessed.Results:There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9), swelling (n=6), restriction of elbow motion (n=6), prominence of lateral condylar region (n=4), valgus deformity (n=4) were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12), fish tail appearance (n=7), premature epiphyseal closure (n=2) were other observations. LES averaged 8.12 (range, 6.66-9.54) at final followup.Conclusions:There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient's age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

Severely Displaced and Rotated Lateral Condylar Fracture of Humerus in Children

Eight children between 4 and 10 years old with displaced and rotated fractures of the lateral humeral condyle were treated by open reduction and internal fixation. In all cases union occurred. There were no complications apart from one case developed stiff elbow which need manipulation under anaesthesia later on.

Diagnosis and Treatment of the Lateral Condylar Fracture of Humerus Traversing the Capitulum in Children

Diagnosis and Treatment of the Lateral Condylar Fracture of Humerus Traversing the Capitulum in Children