Lateral Humeral Condyle Fractures Research Articles

Percutaneous fixation of pediatric humeral lateral condyle fractures

Background Traditionally, the initially nondisplaced pediatric humeral lateral condyle fractures were treated conservatively, whereas displaced or rotated fractures were treated by open reduction and internal fixation (ORIF). Late displacement and nonunion were reported in some conservatively treated cases, whereas epiphyseal necrosis with or without nonunion and elbow deformity were reported in some cases treated by ORIF. Few studies have highlighted closed reduction and percutaneous fixation (CRPF) of displaced and/or rotated fractures. The aim of this study is to assess the outcome of CRPF for the treatment of pediatric humeral lateral condyle fractures. Patients and methods A prospective study included 45 cases of PHLCFs that were preoperatively classified according to classification by Song and colleagues; all cases were planned to have percutaneous fixation through either in-situ pinning if initially nondisplaced or closed reduction if displaced or rotated. If closed reduction failed, ORIF was done. The functional results were evaluated according to the modified criteria of Aggarwal and colleagues. Results CRPF was successful in 80.48% of cases with displaced and/or rotated fractures, with satisfactory clinical and radiological results and no reported surgery-related complications in any case till the last follow-up, with a mean follow-up duration of 18.6±3.04 months. ORIF was done in only eight cases (representing 19.52% of the studied cases) after failed closed reduction. There was a statistically significant difference (P Conclusion CRPF could be the treatment of choice for potentially unstable lateral humeral condyle fractures avoiding the complications of late displacement and elbow stiffness reported in some conservatively treated case. CRPF is an efficient and minimally invasive treatment option for some displaced and/or rotated fractures with very satisfactory clinical and radiological results. ORIF could be restricted only for certain complex cases or after the failure of CRPF. Level of evidence: Level IV.

The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children.

Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication. Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury. The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture. Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.

Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

Humeral lateral condyle fractures in children: redefining the criteria for displacement.

The aim of this study is to define paediatric lateral humeral condyle fractures prone to later displacement. The authors reviewed 106 children who were treated surgically for this fracture. There were 74 boys and 32 girls with an age range of 3-10 years. The study included 27 minimally displaced and 79 displaced fractures. The average follow-up was 50 months. Binary logistic regression model indicated that 6-8-year-old children with minimally displaced fractures and who underwent immediate surgery have a better chance for satisfactory results. The authors concluded that routine use of 2 mm displacement for treatment decisions should be changed to avoid delayed surgery.

Posterolateral approach for humeral lateral condyle fractures in children.

We proposed a simple posterolateral approach to the articular surface of the trochlea for fresh and late fractures of the humeral lateral condyle. Twenty consecutive cases, 16 fresh and four old fractures, were approached between triceps and anconeus before the age of 15 years. All fractures achieved union in 3 months. Nineteen cases were classified as excellent or good by the Hardacre score after 31.3 months of follow-up. One late fracture with elbow subluxation showed radiographic fragmentation of the capitellum and a fair clinical result. This simple optional approach offers good exposure of intra-articular fracture at the trochlea, especially for late fractures.

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

Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures

There is little consensus on whether Kirschner wire (K-wire) burial is preferable in the management of paediatric lateral humeral condyle fractures. We identified 124 patients from May 2008 to August 2014. Sixty received buried K-wires and 64 received unburied wires. We found no significant difference in the infection rates between groups, but a high rate of skin erosion (23%) in the buried group, with a subsequent high rate of infection in this subgroup (40%). We found a strong association of wire erosion following early surgery. There is a considerable cost saving associated with using unburied wires. We therefore recommend the routine use of unburied wires.

Arthroscopie diagnostique dans le traitement des fractures peu déplacées du condyle huméral latéral de l’enfant

IntroductionIn minimally displaced pediatric lateral humeral condyle fractures, plain radiography cannot be used for accurate differential diagnosis of the cartilage lesion, and other imaging methods have demerits in their accuracy and their accessibility. The purpose of this study was to investigate the usefulness of arthroscopy to diagnose cartilage displacement in minimally displaced fractures. Materials and methodsNine children with minimally displaced lateral humeral condyle fractures, an average of 6.6 years old, underwent combined arthroscopy and fixation surgery. Percutaneous fixation was performed with non-displaced articular surface according to the arthroscopic findings, while in case of displaced fracture under arthroscopy, open fixation was prefered. The difference between the arthroscopic and radiographic findings was investigated. ResultsArticular surface could be arthroscopically visualized in all patients. Under arthroscopy, cartilage hinges were maintained in seven cases and disrupted in two. Non-displaced cartilage disruption was noted in one of these two cases, and percutaneous fixation was performed. A displaced articular surface was noted in the other one, where the patient underwent open surgery. At the last follow-up, an average of 14.7 months postoperatively, union and wide range of motion had been achieved without any complications. ConclusionDiagnosis of fracture displacement by merely using plain radiography was considered to be insufficient for minimally displaced cases. Diagnostic arthroscopy aided in the appropriate selection of either a percutaneous or open fixation method. Level of evidenceLevel IV, therapeutic case series.

Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children

IntroductionIn minimally displaced pediatric lateral humeral condyle fractures, plain radiography cannot be used for accurate differential diagnosis of the cartilage lesion, and other imaging methods have demerits in their accuracy and their accessibility. The purpose of this study was to investigate the usefulness of arthroscopy to diagnose cartilage displacement in minimally displaced fractures. Materials and methodsNine children with minimally displaced lateral humeral condyle fractures, an average of 6.6 years old, underwent combined arthroscopy and fixation surgery. Percutaneous fixation was performed with nondisplaced articular surface according to the arthroscopic findings, while in case of displaced fracture under arthroscopy, open fixation was preferred. The difference between the arthroscopic and radiographic findings was investigated. ResultsArticular surface could be arthroscopically visualized in all patients. Under arthroscopy, cartilage hinges were maintained in seven cases and disrupted in two. Nondisplaced cartilage disruption was noted in one of these two cases, and percutaneous fixation was performed. A displaced articular surface was noted in the other one, where the patient underwent open surgery. At the last follow-up, an average of 14.7 months postoperatively, union and wide range of motion had been achieved without any complications. ConclusionDiagnosis of fracture displacement by merely using plain radiography was considered to be insufficient for minimally displaced cases. Diagnostic arthroscopy aided in the appropriate selection of either a percutaneous or open fixation method. Level of evidenceLevel IV, therapeutic case series.

Comparison of kirschner wires and cannulated screw internal fixation for displaced lateral humeral condyle fracture in skeletally immature patients

Comparison of kirschner wires and cannulated screw internal fixation for displaced lateral humeral condyle fracture in skeletally immature patients

Kirschner wire infections in pediatric orthopaedic surgery.

Few studies have described the presentation, bacteriology, risk factors, and complications of Kirschner wire infections in pediatrics. The purpose of this study is to describe these factors to better understand, prevent, and treat infectious complications of smooth wires. A retrospective review was performed to identify all patients (birth to 16 y) who were hospitalized for Kirschner wire infection from 1995 to 2012. Presentation, hospital course, bacteriology, outcomes, and complications were recorded. A management algorithm was developed from the experience. Kirschner wire infections were present in 12 patients: 5 supracondylar fractures, 3 lateral humeral condylar fractures, a distal tibia physeal fracture, a great toe open fracture, a distal radius fracture, and an elective osteotomy for hallux valgus. The patients presented with cellulitis in 3 cases, soft-tissue abscess in 4 cases, osteomyelitis in 4 cases, and 1 case of toxic shock syndrome. A history of missed appointments or wet dressing was present in 60% of cases. Reoperation was required in 5 patients with abscess, septic arthritis, or osteomyelitis. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen followed by Pseudomonas aeruginosa. Methicillin-resistant S. aureus was not seen. Complications were present in 5 patients and included: loss of range of motion, joint destruction, wound breakdown, catheter migration, and toxic shock syndrome. Infected Kirschner wires are rare and may be maintained in a nonunited bone if the infection is superficial. Infections in this series commonly had a history of missed appointments and wet dressings, which suggests that improved postoperative education may reduce the risk. Osteomyelitis was often preceded by pin-site drainage and failed oral antibiotic therapy. MSSA and Pseudomonas were most commonly cultured and should be considered when empiric antibiotic therapy is necessary. Prognostic level IV.

Treatment of the lateral humeral condylar fractures in children

Treatment of the lateral humeral condylar fractures in children

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

Effect of Fixation Method on Postoperative Complication Rates After Surgical Stabilization of Lateral Humeral Condylar Fractures in Dogs

To assess the impact of stabilization method on the complication rate after lateral humeral condylar fracture (LHCF) repair. Retrospective multicenter clinical cohort study. Dogs (n = 151) with LHCF. Medical records (2004-2012) were reviewed for dogs that had surgical repair of LHCF. Data retrieved included signalment, cause of fracture, evidence of incomplete ossification of the humeral condyle, occurrence of postoperative complications, presence of supracondylar comminution preoperatively, and persistence of an intracondylar fissure postoperatively. Outcome was assessed based on the most recent data available and graded as excellent, good, fair, or poor. LHCF (n = 135) were evaluated in 132 dogs; 61 fractures were stabilized using a transcondylar screw and supracondylar K-wire, 13 using a transcondylar screw and supracondylar screw, and 61 using a transcondylar screw and lateral epicondylar plate. Major complications were significantly (P = .01) more common after stabilization using a transcondylar screw and supracondylar K-wire (28%) than in dogs where a supracondylar screw or lateral epicondylar plate were used (11%). Cases that had postoperative complications were significantly (P = .02) more likely to have a poor outcome. LHCF stabilized using a transcondylar screw and supracondylar K-wire are more likely to have major complications resulting in a poorer outcome than cases stabilized using a supracondylar screw or lateral epicondylar plate.

Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution.

Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. 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). We retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob’s classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. 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. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV.

Percutaneous Pin Removal in the Outpatient Clinic—Do Children Require Analgesia?

Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal. Participating in the study were 240 children between the ages of five and twelve years who had two or three percutaneous pins in the elbow following treatment of a supracondylar humeral fracture or a lateral humeral condyle fracture with closed reduction and percutaneous pinning. The patients were randomized into one of three groups (n = 80) allocated to receive acetaminophen, ibuprofen, or vitamin C (placebo) an hour before pin removal. A pain score was obtained and heart rate measured before pin removal, immediately following the procedure, and ten minutes after pin removal. No significant differences were found among the study groups in terms of the demographic data of sex, age, side of injury, or number of pins. Pain score and heart rate did not exhibit differences that were either statistically significant or clinically relevant. The change from baseline did not differ significantly among the groups for either measure at either of the follow-up times post pin removal. Immediately after pin removal, the mean difference in pain score (and 95% confidence interval [CI]) between the acetaminophen group and the ibuprofen group was 0.10 (-1.03 to 1.23); between the acetaminophen group and the placebo group, 0.35 (-0.78 to 1.48); and between the ibuprofen group and the placebo group, 0.25 (-0.88 to 1.38). The CIs excluded a clinically relevant difference. Pain scores and heart rates returned to preprocedural baseline levels within ten minutes following pin removal. Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.

Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures

PurposeDetermining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap.MethodsA non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement).ResultsDuring pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05).ConclusionOverall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-014-0553-8) contains supplementary material, which is available to authorized users.

Clinical results of lateral humeral condyle fractures in children

Clinical results of lateral humeral condyle fractures in children

English

BACKGROUND: Neglected fracture of the lateral condyle of distal humerus in children is very common. Patients with non union of the lateral condylar fracture have pain, instability or a progressive cubitus valgus deformity, condylar prominence. A neglected displaced lateral humeral condyle fracture remains a difficult problem to treat. The bone ends become indistinct and soft tissue becomes contracted; making anatomic reduction difficult. Moreover an attempt to mobilize the fragment by stripping the soft tissues may lead to avascular necrosis. Several authors have recommended operative treatment for such patients, while others do not recommend operative intervention because stiff elbow and AVN are the usual outcomes. The present study was undertaken to assess the results of open reduction and internal fixation in neglected lateral humeral condyle fracture in children. MATERIAL AND METHODS: This is a prospective study carried out between November 2008 and July 2011 in the department of orthopedics at Teerthanker Mahaveer Medical College and research centre, Moradabad. Eighteen patients (14M:4F) with an average age of 7.3years (range 5.5 to 14 years) who had lateral humeral condyle fracture and reported 3 or more weeks after sustaining injury, were included in the study. The fractures were classified according to the Jacobs system. All patients were operated using the lateral approach and fixation was done using K wire or screw with or without bone grafting. The results were graded as excellent, good, fair or poor according to the modified criteria of Agarwal et al. RESULTS: There were 14 males and 4 females with a mean age of 7 years and 3 months (range 4-14 years). Among the nine (50%) patients who presented between 5 to 8 weeks after injury, the results were excellent in 3, good in 4, fair in 1 and poor in 1 patient. Excellent to good results were seen in all the five (27%) patients presenting between 3-5 weeks of injury. Among four (23%) patients out of total 18 patients who presented between 9-12 weeks of injury, 2 had poor results and 1 each had good and fair results. Maximum number of patients had Jacobs type 2 fractures. In our study 25% of these patients had showed excellent results, whereas only 12.5% of patients with type 3 fracture showed excellent results. Fourteen (n=14) patients underwent internal fixation with K wire and in four patients’ fixation was done by cancellous screws. The commonest complication seen was pin tract infection (n=10), followed by occasional pain (n=5) around the elbow. There were no cases of avascular necrosis. CONCLUSION: Satisfactory functional results can be obtained even in late presenting fractures lateral condyles of the humerus in children with modification of surgical technique.

Paediatric lateral humeral condyle fractures: internal oblique radiographs alter the course of conservative treatment

At first presentation of paediatric humeral lateral condyle fractures, radiological methods such as computerised tomography, ultrasonography, magnetic resonance imaging, arthrography, and internal oblique radiography are used to determine stability. Very few studies show which radiological method should be used to evaluate displacement at follow-up for conservatively treated patients. This study aimed to show that internal oblique radiography is a simple, effective method to determine the subsequent development of fracture displacement in patients with an initially non-displaced or minimally displaced fracture. In this retrospective study, 27 paediatric patients with non-displaced or minimally displaced (<2 mm) humerus lateral condyle fracture were evaluated by elbow anteroposterior radiograph. The degree of fracture displacement was evaluated by anteroposterior then by internal oblique radiographs. The first follow-up was made between the 5th and 8th day and thereafter at intervals of 7-10 days. Of the 27 patients identified with non-displaced or minimally displaced (<2 mm) fracture from the initial anteroposterior radiograph, 16 were accepted as displacement >2 mm as a result of the evaluation of the internal oblique radiography and underwent surgery. At follow-up, 2 of 11 patients were defined with displacement from anteroposterior and internal oblique radiographs and 4 from the internal oblique radiographs and underwent surgery. Conservative treatment was applied to 5 patients. Internal oblique radiography is the best imaging showing subsequent fracture displacement in initially non-displaced or minimally displaced humerus lateral condyle fractures. At the first week follow-up, anteroposterior and particularly internal oblique radiographs should be taken of conservatively treated patients.