Treatment Of Lateral Condyle Fractures Research Articles

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

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

Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study

BackgroundThe purpose of this study was to investigate the clinical and functional outcomes of early versus delayed treatment of pediatric lateral condylar fractures of the humerus with a displacement greater than 2 mm.MethodsSixty-seven children treated surgically at our hospital from March 2016 to September 2021 for lateral condylar fracture of the humerus with displacement > 2 mm were retrospectively analyzed. The children were divided into two groups where early surgery consisted of patients being operated on within 24-h post-injury (n = 36) and delayed surgery consisted of children operated after 24-h post-injury (n = 31). Clinical and functional results were compared between the two groups.ResultsThere were no significant differences between the two groups in terms of operation time, blood loss and incidences of perioperative complications. However, mean length of incision was significantly greater (P < 0.0001) in the delayed treatment group (5.68 ± 1.08 cm) compared to the early treatment group (3.89 ± 0.82 cm). No differences were found in functional outcomes, consisting of the Baumann angle of the affected limb, the carrying angle, Mayo Elbow Performance Score, and Flynn’s criteria at final follow-up.ConclusionsDelay in surgery for more than 24 h after injury does not influence the clinical and functional results for lateral condylar fracture of the humerus with displacement > 2 mm in children. However, delayed open reduction and pinning may increase the incision length possibly due to increased edema.

Surgical Treatment of Lateral Condyle Fractures of the Humerus in Children

Surgical Treatment of Lateral Condyle Fractures of the Humerus in Children

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.

Current Concepts in the Treatment of Lateral Condyle Fractures in Children.

Lateral condyle fractures of the humerus are the second most common fracture about the elbow in children. The injury typically occurs as a result of a varus- or valgus-applied force to the forearm with the elbow in extension. Plain radiographs are sufficient in making the diagnosis; however, an elbow arthrogram permits optimal visualization of the articular surface in minimally displaced fractures. Traditionally, nonsurgical management is indicated for fractures with ≤2 mm of displacement and a congruent articular surface. Closed reduction and percutaneous pinning is performed for fractures with >2 mm of displacement with an intact cartilaginous hinge at the articular surface. Open reduction and internal fixation is often necessary for fractures with ≥4 mm of displacement or if there is articular incongruity. Complications include malunion, delayed presentation, fishtail deformity, lateral spurring, and growth arrest. Evolving management concepts include relative indications for surgical management, the optimal pin configuration, and the use of cannulated screw and bioresorbable fixation.

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.

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

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

Discussion on the classification and treatment strategies of the lateral condylar tibial plateau fractures

Objective To discuss on the ABC classification of the lateral condylar tibial plateau fractures, and to evaluate its clinical application. Methods From March 2013 to June 2015, 87 patients with lateral condylar tibial plateau fracture were treated in our hospital, including 49 males and 34 females with the mean age of 49.1 years (range, 25-76). A new classification system of the lateral condylar tibial plateau fracture, ABC Classification, was used for all the 83 patients. There were 51 patients for type B, 6 for type C, 9 for type AB, 13 for type BC, 4 for type ABC. Surgery approach and fixation method depended on the type of fracture. Anterior-lateral approach and anterolateral locking plate fixation were used to treat type B and AB, and additional marginal plate were used in type AB. Carlson approach and T-buttress plate fixation were used to treat type C. Frosch approach was used to treat type BC and ABC. The radiographic and clinical results were evaluated by using Rasmussen's radiological and HSS grading at 12 months postoperatively respectively. Results 83 patients underwent surgeries successfully, with average time of 121 mins (range, 90-160 mins). With a follow-up rate of 83.1%, 69 patients were followed up for 12-24 months, the mean follow-up time was 14.6 months. There was no significant difference in fracture healing time of different types. The average time for fracture union were 13.5 weeks (range, 12-16 weeks). The mean score of the Rasmussen's radiological grading was 16.9 (range, 13-18). All the results according to HSS grading are excellent and the mean score of the HSS grading was 94.1 (from 82-98). Conclusion CT-based ABC Classification is worthy of popularization and application in clinics, and it is more reliable and instructive in the treatment of lateral condylar tibial plateau fractures. Key words: Tibia fractures; Fracture fixation, internal; Diagnosis

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

Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months) postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS). Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children.

Isometric measurement of wrist-extensor power following surgical treatment of displaced lateral condylar fracture of the humerus in children

Muscle disability is a common sequel after fracture management. Previous research has shown divergent results concerning muscle-power recovery after bone healing. This study has investigated the muscle function of wrist extensors after lateral condylar fracture in children, as evaluated by a hand-held dynamometer and compared with sex- and age-matched children. From 1999 to 2004, 20 patients (13 boys and seven girls; mean age: 9 years and 4 months) with displaced lateral condylar fracture of the humerus were treated by open reduction and internal fixation with Kirschner wires (K-wire). The duration of K-wire fixation was 35 days and the mean follow-up time was 50 months. A total of 180 healthy age-, sex- and weight-matched children were used as control groups. A paired Student's test was applied for the analysis of statistical significance. The range of motion of the elbow and radiographic findings were not significantly different between the injured limb and normal control groups. The maximum isometric power of wrist-extensor muscles after surgical treatment of lateral condylar fracture of the humerus in final follow-up was not statistically different from that in the normal control children. Muscle power therefore recovers to its normal status after the healing of lateral condylar fracture of the humerus in children.

Lateral Humeral Condyle Fractures in Children

The treatment of lateral condyle fractures in children remains controversial. This study investigates whether minimally displaced lateral condyle fractures should be treated surgically and compares different techniques of operative management. The authors retrospectively reviewed medical charts and radiographs of 97 children from two international centers whose therapeutic modalities differed, noting demographic data, fracture features, treatment modalities, complications, and clinical and radiographic results. Long-arm immobilization alone resulted in additional fracture displacement and a higher number of nonunions than did surgical management. The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex. If patients are likely to be noncompliant with treatment, the wires should be buried under the skin to avoid the risk of infection, but this procedure necessitates a second surgery for removal of fixation.

Lateral Humeral Condyle Fractures in Children

The treatment of lateral condyle fractures in children remains controversial. This study investigates whether minimally displaced lateral condyle fractures should be treated surgically and compares different techniques of operative management. The authors retrospectively reviewed medical charts and radiographs of 97 children from two international centers whose therapeutic modalities differed, noting demographic data, fracture features, treatment modalities, complications, and clinical and radiographic results. Long-arm immobilization alone resulted in additional fracture displacement and a higher number of nonunions than did surgical management. The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex. If patients are likely to be noncompliant with treatment, the wires should be buried under the skin to avoid the risk of infection, but this procedure necessitates a second surgery for removal of fixation.

Late Surgical Treatment of Lateral Condylar Fractures in Children

We describe four cases of successful late surgical treatment of lateral condylar fractures of the humerus performed 8 weeks and 2, 5, and 14 years after injury and review the literature on the subject. We suggest that children with symptomatic nonunion and malunion of these fractures can benefit from late surgical treatment at the time of diagnosis. We describe the technique of functional reduction and the regions in which anatomic reduction is precluded by remodeling or gross displacement of the fragment.

The Anatomical and Functional Changes after Treatment of Lateral Condyle Fracture of Humerus

The Anatomical and Functional Changes after Treatment of Lateral Condyle Fracture of Humerus