Applying CRITOE in pediatric elbow trauma: is that a fracture or an ossification center?

Underschultz, Jack; Stagg, Andrew P.; MacGougan, Cameron K.

doi:10.1007/s43678-020-00072-w

Cited by 3 publications

(3 citation statements)

References 3 publications

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“… 1 However, elbow fracture cases may be missed and/or present late due to the presence of cartilaginous ossification centers. 2 , 3 Supracondylar humeral (SCH) fractures are the most frequent fractures around the elbow, accounting for 5% of all pediatric fractures and 50%–70% of elbow fractures with a peak incidence between 4 and 7 years. 4 , 5 Moreover, child abuse should be suspected in cases of fractures in nonambulatory children and with certain fractures patterns such as transphyseal distal humerus fracture.…”

Section: Introductionmentioning

confidence: 99%

Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children

Tarabishi

Almigdad

Rudolf

et al. 2023

Journal of Children's Orthopaedics

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Purpose: This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center. Methods: We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann’s angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes. Results: The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann’s angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered. Conclusions: Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance. Level of evidence: level IV: Retrospective therapeutic study.

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Section: Introductionmentioning

confidence: 99%

Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children

Tarabishi

Almigdad

Rudolf

et al. 2023

Journal of Children's Orthopaedics

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“…1 ) [ 2 ]. The timing of their occurrence varies individually, but follows a strict sequence that is described by the acronym CRITOE (capitellum, radial head, internal epicondyle, trochlea, olecranon, external epicondyle), although variances of this order in the minority of children has been described [ 3 , 4 ]. Apophyseal fusion follows a slightly different order, indicated by the acronym CTE-R-O-I, which has been used in a recent publication by Kunc et al [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…First, the capitellum, trochlea, and external epicondyle fuse together before fusing with the humerus. Later, the radius, olecranon, and internal epicondyle fuse [ 3 ]. Precise knowledge of the location and usual configuration of the six apophyses is necessary to identify potential fractures, avulsions, or apophyseal dislocations.…”

Section: Introductionmentioning

confidence: 99%

Not all that looks fractured is broken—multipartite humeral epicondyles in children

et al. 2022

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Objective Multipartite epicondyles may mimic fractures in the setting of pediatric elbow trauma. This study examines the prevalence of multipartite epicondyles during skeletal development and their association with pediatric elbow fractures. Materials and methods In this retrospective analysis, 4282 elbow radiographs of 1265 elbows of 1210 patients aged 0–17 years were reviewed. The radiographs were analyzed by two radiologists in consensus reading, and the number of visible portions of the medial and lateral epicondyles was noted. For elbows in which epicondylar ossification was not yet visible, the epicondyles were already fused with the humerus or could not be sufficiently evaluated due to projection issues or because osteosynthesis material was excluded. In total, 187 elbows were included for the lateral and 715 for the medial epicondyle analyses. Results No multipartite medial epicondyles were found in patients without history of elbow fracture, whereas 9% of these patients had multipartite lateral epicondyles (p < 0.01). Current or previous elbow fractures increased the prevalence of multipartite epicondyles, with significant lateral predominance (medial epicondyle + 9% vs. lateral + 24%, p < 0.0001). Including all patients regardless of a history of elbow fracture, multipartite medial epicondyles were observed in 3% and multipartite lateral epicondyles in 18% (p < 0.0001). There was no gender difference in the prevalence of multipartition of either epicondyle, regardless of a trauma history. Conclusion Multipartite medial epicondyles occur in patients with current or previous elbow fractures only, whereas multipartite lateral epicondyles may be constitutional. Elbow fractures increase the prevalence of multipartite epicondyles on both sides, with significant lateral predominance. Key Points • Multipartite medial epicondyles should be considered of traumatic origin. • Multipartite lateral epicondyles may be constitutional. • Elbow fractures increase the prevalence of multipartite epicondyles on both sides with lateral predominance.

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Elbow

Angelis

Simoni

2023

Essential Measurements in Pediatric Musculoskeletal Imaging

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Applying CRITOE in pediatric elbow trauma: is that a fracture or an ossification center?

Cited by 3 publications

References 3 publications

Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children

Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children

Not all that looks fractured is broken—multipartite humeral epicondyles in children

Elbow

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