Lateral condylar fractures of the humerus in children

Ganeshalingam, Rekha; Donnan, A; Evans, Owain; Hoq, Monsurul; Camp, Mark; Donnan, Leo

doi:10.1302/0301-620x.100b3.bjj-2017-0814.r1

Cited by 31 publications

(36 citation statements)

References 39 publications

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“…Because displaced pediatric LCFs are intra-articular fractures and epiphyseal fracture types 2 and 4 using the Salter–Harris classification, open reduction and internal fixation are generally recommended, [ 12 , 28 , 29 ] and the surgical approach should be chosen based on visualizing the fracture lines. [ 30 , 31 ] LCF lines are classified according to Milch classification.…”

Section: Discussionmentioning

confidence: 99%

“…[ 32 ] Satisfactory outcomes following open reduction and internal fixation for LCFs have been reported following anatomical reduction of the articular surface and when adequate bone union of the LCFs was obtained. [ 29 , 33 ] Poor outcomes result from inappropriate open reduction and internal fixation, which results in malunion of the articular surface or nonunion of the LCF. In our report, in cases 1 and 3, postoperative radiographs showed increased Baumann angle and decreased carrying angle compared with the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

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Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Tomori

Nanno²,

Takai³

2018

Medicine

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Rationale:Posteromedial dislocations of the elbow with lateral humeral condylar fractures (LCFs) are uncommon, and only isolated cases have been reported in the English-language literature. Because of the complex radiolucent cartilaginous structures and late-appearing ossification centers, radiological diagnosis of elbow dislocations with LCF in children is challenging.Patient Concerns:We report three children with posteromedial elbow dislocation: two patients with Milch type I and one patient with Milch type II LCF.Diagnoses:In our report, radiographs showed only a small bone fragment, and arthrography or computed tomography were helpful diagnostic aids in cases 1 and 3. In contrast, the patient in case 2 was initially misdiagnosed as having an epiphyseal separation of the distal humerus, and open reduction and internal fixation through the posterior approach revealed Milch type II LCF.Interventions:In case 1 and 3, Milch type I LCFs, open reduction and internal fixation was performed through the posterolateral approach. On the other hand, in case 2, Milch type II LCF, open reduction and internal fixation was performed through the posterior approach.Outcomes:Poor reduction of Milch type I LCFs resulted in incongruity of the articular surface and poor cosmetic results in two patients. In case 2, Milch type II LCF, plain radiographs showed adequate healing without elbow deformity and the clinical result was excellent.Lessons:Because LCFs are intra-articular fractures, anatomical reduction is crucial for satisfactory outcomes. We promote awareness of this injury, especially posteromedial dislocation with Milch type I LCF. Preoperative evaluation is helpful for achieving satisfactory outcomes, and open reduction and internal fixation through an anterolateral approach might be most appropriate for Milch type I LCFs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Tomori

Nanno²,

Takai³

2018

Medicine

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“…Delayed LCFH in children is not common, and only a few case series have been reported [ 4 , 5 , 12 , 13 ]. Besides, the optimal choice of treatment for this condition remains controversial [ 2 , 3 , 8 ]. The conservative method possibly results in poor clinical outcomes, including pain, instability of elbow joint, cubitus valgus deformity, and resultant ulnar nerve palsy [ 3 – 5 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Utilization of Kirschner wire (KW) for the fixation of LCHF with an early-delayed presentation is a cost-effective choice [ 3 , 8 , 9 ], so it is our preferred choice before the introduction of biodegradable pin (BP). Early-delayed presentation is defined as a period between 3 to 12 weeks from injury.…”

Section: Introductionmentioning

confidence: 99%

Biodegradable pins for lateral condylar fracture of the humerus with an early delayed presentation in children: a retrospective study of biodegradable pin vs. Kirschner wire

Rai

Gao

et al. 2020

BMC Musculoskelet Disord

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Background The clinical outcome of open reduction and internal fixation (ORIF) for delayed lateral condylar fracture of the humerus (LCFH) varies in different studies, but ORIF for LCFH with an early-delayed presentation usually resulted in significant improvement of elbow function. Early delayed presentation is defined as a period of 3 to 12 weeks from the injury. This study aims to compare the clinical outcomes of biodegradable pin (BP) vs. Kirschner wire (KW) in the treatment of LCFH with an early delayed presentation. Methods LCFH with an early-delayed presentation treated with KW or BP were retrospectively reviewed in our hospital. The patients were divided into two groups KW (n = 17) and BP group (n = 26). Baseline information, including sex, age, operative side, duration from injury to surgery, and implant choice, was reviewed. Radiographs and medical records were collected from the Hospital Database. Results In all, 17 patients (male/female, 9/8) in KW and 26 patients (male/female,13/13) in the BP group were included. The age showed no statistically significant difference between the KW (52.3 ± 10.2, month) and the BP (56.1 ± 10.7, month), (P = 0.258). At the last follow-up, there existed no statistically significant difference between the two groups concerning Baumann’s angle (P = 0.272) and carrying angle (P = 0.911). The MEPS at the last follow-up was better in the KW group (91.1 ± 2.7) than the BP group (89.2 ± 3.0), (P = 0.048). There was no case of nonunion or malunion in both groups. The incidence of fishtail deformity was (8/17, 47.1%) in KW and (13/26, 50%) in the BP group. The incidence of lateral prominence was (5/17, 29.4%) in the KW and (7/26, 26.9%) in the BP group. Furthermore, the incidence of implant prominence was higher in KW (12/17, 70.6%) than BP (0) (P < 0.001). Conclusion Open reduction and internal fixation for LCFH with an early-delayed presentation produced satisfactory outcomes. Biodegradable pin is a good alternative to Kirschner wire, with comparable clinical outcomes.

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“…Surgery is highly recommended for displaced and unstable LCF in order to avoid complications. [ 3 ] KW is a cost-effective choice for fixation, but whether it should be buried under the skin remains controversial. [ 4 , 5 ] Biodegradable pin (BP) has been used to treat pediatric fractures, [ 6 – 8 ] but certain complications, including osteolysis, loosening, and resultant secondary displacement, have been reported.…”

Section: Introductionmentioning

confidence: 99%

Is biodegradable pin a good choice for lateral condylar fracture of humerus in children

Rai

Liu

et al. 2020

Medicine

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Introduction: Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW. Material and methods: Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group. Results: In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group ( P < .001). Conclusions: Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.

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Lateral condylar fractures of the humerus in children

Cited by 31 publications

References 39 publications

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Biodegradable pins for lateral condylar fracture of the humerus with an early delayed presentation in children: a retrospective study of biodegradable pin vs. Kirschner wire

Is biodegradable pin a good choice for lateral condylar fracture of humerus in children

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