Lateral Humeral Condyle Fractures Research Articles

Incidence, risk factors and outcomes of avascular necrosis occurring after humeral lateral condyle fractures.

Avascular necrosis (AVN) of the distal humerus is a known complication of lateral condyle fractures yet the specific rate of occurrence is unknown. The purposes of this study are to analyze the incidence, outcomes, and risk factors for AVN following lateral condyle fractures. A retrospective chart review of children diagnosed with a lateral condyle fracture between 2001 and 2014 at level-1 tertiary pediatric center was completed. Demographic data, Weiss classification, time from injury to surgery, operative vs. nonoperative management, open vs. closed reduction, and type of fixation were studied. For patients with radiographs consistent with AVN at any point in their care, elbow range of motion (ROM), pain, and deformity were measured at last follow up. Of the 500 patients evaluated, the incidence of AVN was 1.4%. All cases of AVN were following open reduction and percutaneous fixation (P = 0.01) as initial treatment. Type III fractures were significantly associated with AVN (P = 0.041). After average follow up of 59 weeks (range: 24-150 weeks), all patients regain full ROM except one patient who lacked of 15° of extension and 10° of flexion. Five patients were asymptomatic while two patients had mild pain. There was no radiographic evidence of valgus or varus deformity at final follow up. AVN following lateral condyle fractures is rare with a rate of only 1.4%. Type III fractures and open reduction were significantly associated with AVN. Provided no residual deformity and reconstitution of avascular bone, good outcomes can be expected.

Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow - A Systematic Review.

ObjectiveLateral humeral condyle fractures are the second most common elbow fractures in children. Both K-wire fixation and screw fixation have been advocated as suitable treatment options for displaced fractures. This study aimed to identify which fixation method was associated with the best functional outcomes.MethodsA systematic review was conducted. Studies reporting functional outcomes following surgical fixation of lateral condyle fractures were included for review. The primary outcome measure was functional outcome. The secondary outcome measure was major complications. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies.ResultsTen retrospective non-randomised, comparative studies were eligible and included. No randomised-controlled trials were identified. The highest rate of excellent functional outcomes was seen with screw fixation (120/126 [95%]), compared with K-wire fixation (135/162 [86%]). The incidence of major complications was comparable, with complications in 6/95 (6%) of screw fixations and 6/141 (4%) K-wire fixations. A small sample of data on closed reduction demonstrated excellent functional results in 73 of 76 (96%) of patients. Closed reduction of displaced fractures is associated with a significant learning curve however.ConclusionThe evidence was of poor quality and comprised of retrospective case series. This prevented meta-analysis and any firm conclusions being drawn from the available data. Screw fixation may be associated with improved functional outcomes. Complication rates between the two methods are comparable. Further prospective studies are recommended.

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.

Impact of Transverse Ultrasound Images on the Classification and Treatment of Pediatric Lateral Humeral Condyle Fractures.

Pediatric lateral humeral condyle fractures (LHCFs) are sometimes misdiagnosed and inappropriately treated on the basis of x-ray radiographs because cartilage cannot be seen on radiographs. However, as a useful technique, transverse ultrasonography can accurately and readily determine the integrity of the cartilage hinge in pediatric LHCFs. The purpose of this study was to assess the reliability of the Jakob classification, the treatment plan, and the necessity for further examination of pediatric LHCFs with the use of x-ray with and without transverse ultrasound images. Five pediatric orthopaedic surgeons with different levels of experience evaluated 62 cases on the basis of the use of x-ray alone and x-ray combined with transverse ultrasound images. These 2 types of evaluations were repeated after an interval of 4 to 6 weeks. At the time of each evaluation, all observers were asked to classify the fractures according to the Jakob classification, to formulate treatment plans, and to determine whether further examinations were required. After the training of transverse ultrasound image interpretation, the interobserver reliability of the Jakob classification significantly improved from fair (a kappa of 0.54) to moderate (a kappa of 0.71) with the addition of transverse ultrasound images. The treatment plan was changed from conservative treatment to surgical treatment in 7% of the ratings but from surgical treatment to conservative treatment in 15% of the ratings after reviewing the ultrasound images, and the difference was statistically significant (P=0.003). The use of the Jakob classification and a treatment plan for pediatric LHCFs can be optimized by the addition of transverse ultrasound images, especially after training for transverse ultrasound image interpretation. Level III-diagnostic study.

Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children.

Background:Lateral humeral condyle fractures are the second most common elbow fracture in children. Displaced and rotated fractures require stabilization and reduction. Kirschner wires (K-wires) are most commonly used in the fixation of these fractures. Here, we introduce a new fixation method that uses an absorbable screw. We aim to determine if it is feasible to treat lateral humeral condyle fractures with an absorbable screw by comparing functional outcomes following absorbable screw fixation vs. K-wire fixation.Methods:Between May 2007 and September 2010, 86 patients were treated with absorbable screws (43 patients) or K-wire (43 patients). All patients had been diagnosed with lateral condyle fractures that were classified as either Jacob type II (unstable) or III. One absorbable screw (3.5 mm-diameter) was used for fixation in 1 group, while two 1.6 to 1.8 mm K-wires were used in the other group. Patients were followed 6 months about the elbow function according to Broberg and Morrey standard. On 5–7 years, the patients were followed about the carrying angle (valgus deformities and varus deformities), range of motion (flexion loss and extension loss), prominent lateral condyle, symptomatic implants, and fishtail deformity.Results:Anatomic reduction was achieved in all patients. Each group had one radial nerve injury that were present preoperatively. Nerve function recovered spontaneously within 3 to 4 weeks of surgery in both patients. No patient developed necrosis of the capitulum in both groups. Nine patients in K-wires group and 2 in absorbable screw group developed symptomatic implants (P = .048). On the sixth month, there was no significant difference on elbow function according to Broberg and Morrey standard. On 5 to 7 years (average, 6.7 ± 1.3 years), valgus deformities was 6.8 ± 1.2 vs 5.7 ± 0.8, varus deformities was 7.2 ± 1.5 vs 5.1 ± 1.9, flexion loss was 12.4 ± 2.2 vs 9.5 ± 3.1, extension loss was 11.1 ± 3.1 vs 10.2 ± 2.7, prominent lateral condyle was 27.9% vs 37.2%, fishtail deformity was 7.3% vs 4.9%, no significant difference between these groups.Conclusions:Open reduction with absorbable screw fixation is feasible and safe for the treatment of lateral condyle fractures of the humerus in children.Level of Evidence:Therapeutic III.

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.

Kirschner Wire Fixation with and without Tension Band Wiring for Treatment of Fracture of the Lateral Humeral Condyle in Children

Kirschner wires (K-wires) are commonly used to treat displaced lateral humeral condyle fracture in children. However, K-wire fixation alone is insufficient for early elbow range of motion (ROM) exercises. Fixation combined with tension band wiring (TBW) converts distraction forces into compression forces, which provides more rigid fixation than K-wire fixation alone. Here, we retrospectively evaluated clinical outcomes of patients with displaced lateral humeral condyle fracture treated with TBW or K-wires only. We identified children with lateral condyle fractures who had undergone surgery during the period from April 2000 through March 2014. Nineteen patients were classified into 2 groups according to treatment: 10 were allocated to the TBW group (TBW and K-wires) and 9 to the K-wires group. The mean interval from injury to surgery was 5.1 days in both groups. Fractures were classified by using the Jacob's and Milch's classifications. In addition, we collected and analyzed data on postoperative complications, radiological and clinical evaluations, ROM, and Flynn's criteria. Mean duration of follow-up was 14.4 months in the TBW group and 5.9 months in the K-wires group. Mean bone union time was 38.6 days and 49.8 days, respectively. Mean duration of cast/splint use was significantly longer for K-wires patients (49.8 days) than for TBW patients (35.8 days). Range of flexion at the final follow-up was significantly lower in the K-wires group. TBW fixation appears to be the optimal treatment for displaced lateral humeral condyle fracture in children, as it facilitates early active range of motion exercises.

Patient-Reported Functional Outcomes Following Treatment of Pediatric Lateral Humeral Condyle Fractures: Open Reduction is Better than Percutaneous for Operative Injuries

Purpose: Fractures of the lateral humeral condyle are relatively common in children, accounting for approximately 20% of all pediatric elbow fractures. Long-term functional and clinical outcomes remain equivocal between closed management and operative fixation. Our aim was to determine whether a functional difference exists between these treatment types. Methods: We retrospectively reviewed all children with acute lateral humeral condyle fractures treated at our level-1 pediatric trauma center from 2008-2017 with minimum 1 year follow-up. Patients were sub-classified based on injury severity and fracture displacement into (1) mild (minimally displaced 2 mm displacement), or (3) severe …

Patient-Reported Functional Outcomes Following Treatment of Pediatric Lateral Humeral Condyle Fractures: Open Reduction is Better than Percutaneous for Operative Injuries

Patient-Reported Functional Outcomes Following Treatment of Pediatric Lateral Humeral Condyle Fractures: Open Reduction is Better than Percutaneous for Operative Injuries

Retrospective Evaluation of The Result of Fixation of Lateral Humeral Condyle Fractures by K-Wires versus Cannulated Screws in Children

Retrospective Evaluation of The Result of Fixation of Lateral Humeral Condyle Fractures by K-Wires versus Cannulated Screws in Children

Retrospective Evaluation of The Result of Fixation of Lateral Humeral Condyle Fractures by K-Wires versus Cannulated Screws in Children

Background: fractures of the lateral condyle of the humerus represent the second most common type of fracture of the elbow in children. Although this injury is seen at all ages, it is predominately observed in children aged between 5 and 10 years. Objective: the purpose of this study is retrospective evaluation of the results of fixation of lateral humeral condyle by K-wires versus cannulated screws in children by assessment of: 1-Time to full union. 2-Range of motion.3- Percentage of complications. 4-According to Hardacre criteria. Patients and methods: a retrospective study for evaluation of the result of fixation of lateral humeral condyle fractures in children by K-wires vs cannulated screws. Our series was conducted in Al-Azher University Hospitals. 20 patients with humeral condyle fractures were treated by K-wires and cannulated screws. Results: in group A patients presented by complications as following: extension lag 1 (10%), delayed union (healing at 3–6 months) 1 (10%), revision 1 (loss of reduction at the 3rd day of operation and required revision using pin fixation) (10%), fish tail deformity 0 (0%) and 7 (70%) had no complications. While in group B: extension lag 1 (10%), delayed union 2 (20%), nonunion 1 (10%) (Not healed at greater than 6 months and reoperated using bone graft and pin fixation), revision 0 (0%), fish tail deformity 1 (10%), pin tract infection 1 (10%) and 4 (40%) had no complications. Conclusion: our study supports that screw fixation may be a viable option, with no nonunions and fewer complications than pin fixation.

Osteochondral flap fracture of the coronoid in pediatric humeral lateral condyle

Rationale:Osteochondral flap fractures of the elbow are rare in children. To the best of our knowledge, only 12 cases are reported in the literature. Only 1 case was accompanied with lateral condyle fracture classified as Milch I, which was nondisplaced. The mechanism of these injuries is not explained in detail, and the treatment methods are not discussed. Here, we present 3 cases of osteochondral flap fracture of the ulnar coronoid process with accompanying obvious displacement of the lateral condyle fracture.Patient concerns:All patients fell into one of their outstretched arms, which caused elbow pain and functional limitation.Diagnosis:All 3 patients were diagnosed with lateral condyle fracture of the humerus and osteochondral flap fracture of the ulnar coronoid process.Interventions:All patients underwent open reduction and internal fixation.Outcomes:At 3 months after the operation, they regained full range of motion of the limb and had no elbow instability.Lessons:Osteochondral flap fracture should be considered when there is a bone mass in the elbow space with accompanying displacement of the humeral lateral condyle fracture.

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.

Minimally Displaced Humeral Lateral Condyle Fractures: Immobilize or Operate When Stability Is Unclear?

Either casting or in situ fixation (to prevent displacement) are recommended for minimally displaced pediatric lateral condyle fractures of indeterminate stability with ≤2 mm lateral displacement and narrowed fracture extension to the epiphyseal articular cartilage. This study compares casting only, acute prophylactic in situ pinning, and surgery if casting fails due to displacement. In total, 738 fractures at a level 1 trauma center between 2008 and 2014 were reviewed. All fractures were assigned a Song classification and Song 2 fractures followed to union were analyzed. Worsening displacement was defined as an increase in Song stage. Patients were grouped per treatment: (1) cast only; (2) in situ pinning; or (3) closed or open reduction percutaneous pinning after displacement during attempted cast treatment. In total, 139 fractures were included and 45 (32%) underwent surgery. Among 114 fractures intended for casting, only 20 (18%) displaced and needed surgery. This implies 82% of fractures prophylactically pinned in situ may have remained stable in a cast. On average, displaced fractures were noted 6.5 (2 to 13) days after presentation and required 1 extra clinic visit and week of immobilization without increased complications. Surgeons chose open reduction percutaneous pinning more often for displaced fractures. Our data estimate 82% of Song 2 fractures never meaningfully displace in a cast. Meaningful displacements occur in <2 weeks. Benefits of prophylactic pinning include 1 less x-ray and clinic visit in exchange for a clinically insignificant lateral cortex reduction and inherent surgical risks. Compliance, surgical scheduling, and a higher rate of open reduction after displacement should influence early treatment decisions. Level III.

Diagnostic échographique des fractures peu déplacées du condyle huméral chez l’enfant : une nouvelle technique

IntroductionManagement of minimally displaced lateral humeral condyle fractures in pediatric patients is controversial. This is primarily because with current imaging modalities it is difficult to accurately and conveniently determine the stability of the fractures by detecting the integrity of the cartilage hinge. Nevertheless, transverse ultrasonography has not been intensively reported in previous studies. HypothesisTransverse ultrasonography can determine the integrity of the cartilage hinge in minimally displaced lateral condyle fractures. Materials and methodsWe retrospectively reviewed the medical records of 39 pediatric patients with minimally displaced fractures of the lateral humeral condyle who underwent transverse ultrasonography between 2014 and 2017. Conservative treatment was given to pediatric patients with intact cartilage hinges that had been confirmed by transverse ultrasound images. Surgical treatment was recommended for pediatric patients with disrupted cartilage hinges. Data regarding healing of the lateral humeral condyle fractures were recorded and analyzed. ResultsAccording to transverse ultrasonography, there were 14 children with intact cartilage hinges and 25 children with disrupted cartilage hinges. Fourteen children with intact cartilage hinges of the fracture were treated conservatively, and none of them showed secondary displacement. There were 16 children in whom there was surgical intervention, and 9 other children decided to have conservative treatment among the 25 children with disruption of the cartilage hinge. Five of these 9 children who underwent conservative treatment were found to have further displacement during an average of 12.6 days after the fracture event, and no other patient was found to have further displacement. ConclusionTransverse ultrasonography can simply and accurately determine the stability of minimally displaced lateral condyle fractures without sedation, ionizing radiation or invasive techniques. We recommend routine use of transverse ultrasonography to detect stability of the fractures, which can effectively avoid inadequate treatment and unnecessary surgery in pediatric patients with minimally displaced fractures of the lateral humeral condyle. Level of evidenceIV, retrospective cohort study.

A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children

IntroductionManagement of minimally displaced lateral humeral condyle fractures in pediatric patients is controversial. This is primarily because with current imaging modalities it is difficult to accurately and conveniently determine the stability of the fractures by detecting the integrity of the cartilage hinge. Nevertheless, transverse ultrasonography has not been intensively reported in previous studies. HypothesisTransverse ultrasonography can determine the integrity of the cartilage hinge in minimally displaced lateral condyle fractures. Materials and methodsWe retrospectively reviewed the medical records of 39 pediatric patients with minimally displaced fractures of the lateral humeral condyle who underwent transverse ultrasonography between 2014 and 2017. Conservative treatment was given to pediatric patients with intact cartilage hinges that had been confirmed by transverse ultrasound images. Surgical treatment was recommended for pediatric patients with disrupted cartilage hinges. Data regarding healing of the lateral humeral condyle fractures were recorded and analyzed. ResultsAccording to transverse ultrasonography, there were 14 children with intact cartilage hinges and 25 children with disrupted cartilage hinges. Fourteen children with intact cartilage hinges of the fracture were treated conservatively, and none of them showed secondary displacement. There were 16 children in whom there was surgical intervention, and 9 other children decided to have conservative treatment among the 25 children with disruption of the cartilage hinge. Five of these 9 children who underwent conservative treatment were found to have further displacement during an average of 12.6 days after the fracture event, and no other patient was found to have further displacement. ConclusionTransverse ultrasonography can simply and accurately determine the stability of minimally displaced lateral condyle fractures without sedation, ionizing radiation or invasive techniques. We recommend routine use of transverse ultrasonography to detect stability of the fractures, which can effectively avoid inadequate treatment and unnecessary surgery in pediatric patients with minimally displaced fractures of the lateral humeral condyle. Level of evidenceIV, retrospective cohort study.

Opioid-free anaesthesia (OFA) in a springer spaniel sustaining a lateral humeral condylar fracture undergoing surgical repair

A two-year, three-month-old male entire springer spaniel presented for right thoracic limb lameness. Radiographs of both elbows revealed a right lateral humeral condylar fracture. Local anaesthesia using bupivacaine was supplied...

Treatment principles and outcome after fractures of the lateral humeral condyle in children

Fractures of the lateral humeral condyle with displacement (>2 mm; <2 mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive X‑rays. A retrospective data analysis of all lateral humeral condyles in children <16 years old treated between 2005 and 2014 was carried out. The patients were classified according to the fracture stability at the time of the incident (primarily stable or unstable) and after 4 days (secondarily stable or unstable) using conventional X‑ray images. Atotal of 89fractures of the lateral humeral condyle were treated (mean age 6.4years, range 0.9-14 years). Of the fractures 52 (58%) were initially not displaced and 37 (42%) were initially displaced. The latter underwent open reduction and stabilization by osteosynthesis (primarily stable). Of the 52 initially not displaced fractures 35 remained stable and conservative treatment in a plaster cast was performed (primarily and secondarily stable). In 8 out of 52cases asecondary displacement (>2 mm articular gap) occurred after an average of 6 days (range 3-10 days) and operative treatment was initiated (primarily stable and secondarily unstable). No follow-up x‑ray could be performed in 2 of the 52fractures and at the end of treatment the fractures healed with displacement (primarily stable and secondarily unstable). In 7 of the 52fractures operative treatment was performed although no displacement (primarily stable) was initially documented (overtreatment). The outcome of the whole study cohort was comparable with that described in the literature. Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with astable osteosynthesis must be initiated.

Closed reduction and percutaneous pinning for the treatment of lateral humeral condyle fracture

Objective The aim of the present study was to evaluate the result of treatment of recent fracture of the lateral humeral condyle in children using closed reduction and percutaneous pinning. Background Few reports have focused on closed reduction and internal fixation of fractures of the lateral humeral condyle in children. We prospectively studied closed reduction and internal fixation to determine its usefulness as the treatment for fractures of the lateral condyle of the humerus in children. Patients and methods The lateral condylar humeral fractures were classified into three groups according to the degree of displacement and the fracture pattern as determined on four radiographic views (Jacob classification). On the basis of this classification system, we prospectively treated 60 fractures and assessed the quality of closed reduction according to the criteria of Hardacre and colleagues Results All six patients of stage 1 fractures were reduced to 1 mm of residual displacement with excellent results. A total of 42, stage 2 fractures were reduced to less than 2 mm of displacement with excellent results and four patients had good results. In six patients of stage 3 had excellent results and two patients had good result. There were no major complications such as early physeal arrest, osteonecrosis of the trochlea or capitellum, nonunion, malunion or osteomyelitis. Conclusion Closed reduction and internal fixation is an effective treatment for lateral humeral condylar fractures of the humerus in children. If fracture displacement, after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.

Correction of cubitus varus with lateral closed wedge osteotomy and cross k-wire fixation: results of a prospective series of 19 patients

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy. Various complex corrective osteotomies have been described in literature with no consensus. We conducted this study to evaluate whether a simple lateral closed wedge osteotomy can give predictably good results in these patients. Materials and Methods: Nineteen children with malunited supracondylar fracture humerus leading to cubitus varus deformity underwent lateral closed wedge osteotomy, which was fixed with cross K-wires. Patients were evaluated for carrying angle, elbow range of motion, complications if any, and radiological correction of humeroulnar angle. Results: Osteotomy healed in all patients by 8 weeks (range 4–8 weeks, mean of 5.5 weeks). Excellent correction was achieved in 18 patients, whereas one patient had inadequate correction. Preoperative varus ranging from 10° to 30° (average – 17°) improved to 0°–12° valgus (average-8°). Two patients had minor complications in the form of pin tract infections which resolved with local care and antibiotics. There was no loss of correction or pin loosening. Sixteen patients had excellent result, whereas three patients had fair result as per Bellemore's criteria. Conclusion: Complex three-dimensional osteotomy is not always necessary for cubitus varus correction and a simple lateral closed wedge osteotomy fixed using cross K-wires can give good results with proper planning and execution.