Lateral Condyle 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

Finite element analysis of Kirschner wire fixation for lateral condyle fracture in children in the sagittal plane.

This study aims to find the optimal arrangement of the Kirschner wire (K-wire) in the sagittal plane for fixation of a pediatric lateral condylar humeral fracture (Milch type II) by using finite element analysis (FEA). A model of lateral condyle fracture in a 6-year-old boy was developed, and an XYZ coordinate system was established based on this model. The YZ plane was defined as the sagittal plane to investigate the impact of the angle formed by the first and second K-wires on stability. Two configurations were studied for each angle: parallel and divergent. Evaluation indicators included the maximum displacement of the fracture fragment and the maximum von Mises stress in the pins and bone. The model with a -60° angle showed the best performance in both evaluation indicators. The parallel and divergent pin configurations had different performances in each group. The displacement results for negative angles were similar, and this result was better than those for positive angles. We successfully created a model of pediatric lateral condyle humerus fracture (Milch type II) and performed K-wire fixation with varying sagittal plane configurations, combined with FEA. Our findings demonstrate that the angle of -60° between the two pins in the sagittal plane provided the highest level of stability, with divergent configurations proving superior to parallel pinning at this angle.

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.

Nonunion of the Lateral Condyle of Humerus

Lateral condyle humerus fracture in children is known to have union complications. Delay in diagnosis, pull at the common extensor origin, precarious blood supply and lack of appropriate treatment may result in non-union. Non-union of lateral condyle can lead to progressive cubitus valgus. Progressive cubitus valgus may be associated with pain, instability and stiffness of the elbow and ulnar nerve paresis. Plain radiographs of the elbow are required for the assessment of the joint congruity, size of the lateral condyle fragment, extent of the elbow deformity and physis status. Corrective osteotomy with anterior transposition of the ulnar nerve gives good cosmetic and functional results.

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.

Concomitant Posteromedial Elbow Dislocation with Lateral Condyle Humerus Fracture in a 7 Years Old – A Rare Case Report and Review of the Literature

Introduction:Traumatic dislocations of the elbow are a rare injury in children. Concomitant elbow dislocations and lateral condyle fractures are even rarer. There is a wide variability in the outcomes of these injuries as there is no consensus regarding its management. We report one such rare case in a 7-year-old child.Case Report:A 7-year-old child was brought to the emergency room with an alleged history of fall on outstretched hand sustaining injury to the left elbow. He was diagnosed with a posteromedial elbow dislocation, along with fracture of the lateral condyle. The patient underwent emergency reduction of the elbow under appropriate anesthesia following which there was persistence of varus and valgus instability, for which the lateral condyle was fixed with a standard pinning through a lateral approach with three Kirschner wires. The patient was immobilized for 6 weeks in a plaster, after which mobilization was started. At 3 months follow-up, the patient showed good functional outcome with full range of motion.Conclusion:We report an exceedingly rare case of concomitant elbow dislocation and fracture of the lateral condyle in children. If emergent reduction of the dislocation and anatomic reduction of the fracture is achieved, satisfactory outcomes can be expected. Delayed recovery of the elbow motion is common, but full range of motion can be expected in the long run.

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.

Functional outcome following internal fixation of rare type IV capitellum fractures using varied fixation methods: A case series

Background: Capitellum fractures are very rare injuries, accounting for less than 1% of elbow fractures. These fractures are difficult to interpret on a plain radiograph and usually require a computed tomography scan to understand the complexity of the fracture. Treatment of such fractures vary from conservative treatment in the form of closed reduction and immobilization, excision of the fragment to open reduction and internal fixation with K wires, partially threaded 4mm cancellous screws or Herbert screws. In this paper we present the outcome of four cases of Type IV capitellum fractures that were managed operatively by different methods. Materials & Methods:Four patients were treated in our hospital from 2018 to 2019, for Type IV capitellum fractures. The mechanism of injury was a fall on the out stretched hand in three patients while the fourth patient was involved in a motor cycle accident. The fractures were equally distributed on either elbows, two on each side. The three males patients were aged between 18 to 30 years while the lone female was 40 years of age. All patients were operated in the supine position under general anaesthesia, using a tourniquet and with fluoroscopic guidance. Surgery was performed through an extended lateral Kocher’s approach. Definitive fixation in two patients was by using 2.7mm Herbert screws alone while in one with a lateral condyle humerus fracture, fixation was supplemented using plate and screws. K-wire fixation was used for one patient. Results: 2 patient attained a score of excellent in the Mayo Elbow Performance Score evaluation while 1 patient each had a good and a fair score. There was no evidence of arthritis, avascular necrosis or heterotopic ossification till 1 year of follow-up. Conclusion: Flawless reduction and fixation of the fragment with appropriate postoperative rehabilitation protocol are crucial to achieving optimal results.

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.

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.

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.

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.

Hierarchical structure of Five-shu points and Source-point of Triple Energizer Meridian in rabbits

To study the position and hierarchical structure of Five-shu points, i．e., "Guanchong" (TE1), "Yemen" (TE2), "Zhongzhu" (TE3), "Yangchi" (TE4) and "Zhigou" (TE6), and the Source-point "Tianjing" (TE10) of the Triple Energizer (TE) Meridian in the rabbit. Based on WHO Standard Acupuncture Point Locations in the Western Pacific Region (WHO Standard) and National Standard (GB/T 22103-2008) for Acupuncture Point Locations in human body, and combined with X-ray images, the hierarchical structure of Five-shu points and Source-point of the TE Meridian were observed in ten New Zealand rabbits. The acupoint locations were determined by comparing the same name tissues of the rabbits and human body after dissecting the above-mentioned acupoints. After inserting acupuncture needles into the aforementioned acupoints, the relationship between the acupuncture needle and adjacent structure were dissected and measured. "Guanchong" (TE1) was located on the lateral side of the 4th terminal phalanx, and behind the corner of the onyx root. When needled, the penetrated tissues of the acupuncture needle are skin, superficial fascia, deep fascia, and the root region of the 4th phalanx, respectively. "Yemen" (TE2) was located between the 4th and 5th onyxes, at the depression of intersection of coat hair superior to the fingerweb edge. When needled, the penetrated tissues of the acupuncture needle are the superficial fascia, deep fascia and lumbrical muscles of the forepaw, respectively. "Zhongzhu" (TE3) was located between the 4th and 5th metacarpal bones, at the depression proximal to the 4th metacarpophalangeal joint. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and lumbrical muscle, respectively. "Yangchi" (TE4) was positioned at the dorsal side of the forepaw, and the surface connection line between the accessory and radial bones intersected with the depression of the extensor digitorum communis on the ulnar side. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and the ulnar side of the common extensor tendon, respectively. "Zhigou" (TE6) was positioned between the radius and ulna, on the posterior aspect of the forelimb and 3 Bone-cun proximal to the distal dorsal forepaw crease. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and the extensor digitorum, respectively. "Tianjing" (TE10) was located at the junction of the body of humerus and the lateral condyle of humerus, on the posterior aspect of the elbow and proximal to the prominence of the olecranon. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and triceps brachii muscle, respectively. The Five-shu points and Source-point of the TE Meridian on the forelimb in rabbits are innervated by the cutaneous branches of the ulnar radial nerve and the medial brachial cutaneous nerve at the superficial layer, and by the branches of the ulnar nerve and radial nerve in the deep layer, accompanied with cephalic vein and forearm blood vessels and their branches.

Cubitus Valgus with Tardy Ulnar Nerve Palsy - Functional Outcome of Milch Osteotomy without Anterior Transposition of Ulnar Nerve.

Introduction:To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.Material and Methods:Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.Results:The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.Conclusion:Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.

3D Printing Aided Elbow Deformity Correction

Introduction: Fracture of lateral condyle of humerus is known for nonunion, if not treated properly in children, often leads to a cubitus valgus deformity. For the late presenting cases with deformity and restricted range of motion, surgical management is often challenging, and an appropriate preoperative planning is required. Case Report: We report a case of an un-united fracture of the lateral condyle of the humerus in an adult with a cubitus valgus deformity with early tardy ulnar nerve palsy. He was treated by corrective osteotomy with bone grafting of the nonunion and internal fixation with contoured plates. A virtual preoperative surgical planning was done using 3D printing to define the exact location and direction of the osteotomy, plate contouring and likely place of screw placement to achieve full correction of the elbow deformity. Results: There was good correction of deformity, with union of the nonunion and osteotomy, at three months follows- up. At one year, there was complete recovery of ulnar nerve palsy with excellent function of the elbow and hand. Conclusion: 3D printing is effective in treating complex orthopedic cases and deformity correction. Virtual preoperative surgical planning on the computer and on a 3D model help to study the exact site of osteotomy, plate contouring and screw placement to achieve accurate correction of the deformity. Virtual preoperative planning and 3D printing help in reducing the surgical time and help to achieve desired correction of the deformity.

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.