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

Bakarman, Khalid A.; Alsiddiky, Abdul Monem M.; Alzain, Kholoud O.; Al-Khawashki, Hazem; Nasser, Ahmed S. Bin; Alsaleh, Khalid; Al-Jassir, Fawzi F.; Zamzam, Mohammed M.

doi:10.1097/bpb.0000000000000306

Cited by 12 publications

(20 citation statements)

References 20 publications

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“…15 In our study, the odds ratio of having conservative management per month increase in age was statistically significant (2.1), which was contrary to a previous study that reported that the need for surgical fixation showed significant association with older age group. 11 In young children, because of the largely cartilaginous nature of capitellum, the lateral condyle is not always well visualized on plain radiographs, and this makes the clinical diagnosis of lateral condylar fractures and assessment of their epiphyseal extension difficult. [4][5][6] This could partly explain the preference of surgical management over conservative management in younger children.…”

Section: Discussionmentioning

confidence: 99%

“…However, some authors have reported the usage of surgical management even in the minimally displaced fractures and a better chance for satisfactory results subsequently. 11 This points to the fact that there exist wide practice variations in management of lateral condyle elbow fractures in pediatric patients across various centers in the world. Lateral condyle humeral fractures have a risk of displacement because of pull of the extensor muscles on the condyle.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Lateral condyle humeral fractures have a risk of displacement because of pull of the extensor muscles on the condyle. 11,12 Dislocated lateral condylar fracture are defined as fracture gap greater than 2 mm on either antero-posterior (AP) or lateral view x-rays of the elbow. 13,14 Undisplaced fractures (fracture gap less than 2 mm) are typically managed conservatively with an above elbow cast immobilization and close follow-up for displacement.…”

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confidence: 99%

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Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department

James

Chng²,

Ting

et al. 2020

Pediatr Emer Care

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Background: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. Objectives: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.Methods: This was a single-center retrospective study conducted between January 2006 and December 2016.Results: 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. Conclusions: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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department

James

Chng²,

Ting

et al. 2020

Pediatr Emer Care

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“…A systematic review reported that 14.9% (53/355) had secondary fracture displacement during conservative treatment [ 26 ]. Some scholars even proposed that regardless of whether the fracture was displaced or not, all children with HLCFs required surgical treatment [ 27 ]. So far, the diagnosis, clinical classification, and treatment decisions of children with HLCFs have mainly relied on radiographs of the elbow joint.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children

et al. 2021

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Background Humeral lateral condyle fractures (HLCFs) are common paediatric fractures. Radiographs are hard to accurately evaluate and diagnose the damage of articular epiphyseal cartilage in HLCFs. Methods 60 children who should be suspected to be HLCFs in clinical practice from Dec 2015 to Nov 2017 were continuously included as the first part patients. Subsequently, 35 HLCFs patients with complete follow-up information who had no obvious displacement on radiograph were the second part patients. The sensitivity and specificity of radiograph and MRI in diagnosing of HLCFs and their stability were calculated respectively. Calculated the sensitivity and specificity of each scan sequence of MRI in diagnosing of HLCFs osteochondral fractures. The degree of fracture displacement was measured respectively. Compared the ratio of surgical treatment, secondary fracture displacement and complications between the stable fracture group and the unstable fracture group on MRI in part 2 patients. Results Sensitivity of diagnosing HLCFs by MRI was significantly higher than radiograph (100.00% vs. 89.09%, P = 0.03). Sensitivity of diagnosing integrity of trochlear cartilage chain by MRI was 96.30%, which was significantly higher than that by radiograph (62.96%, P < 0.01). The sensitivity of cartilage sensitive sequence (3D-FS-FSPGR/3D-FSPGR) was different with FS-PDWI and FS-T2WI (P = 0.01 and P = 0.02, respectively). The degree of HLCFs displacement by MRI was higher than radiograph (P < 0.05). In the unstable fracture group, 5 cases (45.45%) had a fracture displacement of more than 2 mm on MRI, which was significantly higher than that in stable fracture group (0.00%, P < 0.01). Conclusions MRI is superior to the radiograph of elbow joint in evaluating and diagnosing children HLCFs and their stability. The coronal 3D-FS-FSPGR/3D-FSPGR sequence is a significant sequence for diagnosing osteochondral fractures in HLCFs. MRI can provide important clinical value for treatment decisions of HLCFs without significant displacement.

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“…Previous studies have shown improved outcomes with surgical intervention with displacement 2 mm or greater. 9,10 The goal with surgical intervention is an anatomic reduction of the articular surface, with stable internal fixation to prevent fracture displacement and encourage bony union. For minimally displaced fractures, this may be achieved with closed reduction and internal fixation with Kirshner wires (K-wires) or with percutaneous screw fixation.…”

Section: Introductionmentioning

confidence: 99%

Open reduction of pediatric lateral condyle fractures: a systematic review

et al. 2021

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Introduction Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients’ average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence Level 3.

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

Cited by 12 publications

References 20 publications

Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department

Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department

Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children

Open reduction of pediatric lateral condyle fractures: a systematic review

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