Management of neglected lateral condyle fractures of humerus in children: A retrospective study

Abstract

Background:Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results.Materials and Methods:Twenty two pediatric (≤12 years) patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically) and elbow function (Liverpool Elbow Score, LES) was assessed.Results:There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9), swelling (n=6), restriction of elbow motion (n=6), prominence of lateral condylar region (n=4), valgus deformity (n=4) were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12), fish tail appearance (n=7), premature epiphyseal closure (n=2) were other observations. LES averaged 8.12 (range, 6.66-9.54) at final followup.Conclusions:There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient's age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

Conservative Management of Minimally Displaced (≤2 mm) Fractures of the Lateral Humeral Condyle in Pediatric Patients: A Systematic Review

“…Delayed displacement underneath casting may be difficult to impossible to detect based on history, as subsequent radiographic displacement often does not correlate with clinical symptoms. 26 Studies included in this review found that follow-up radiographs within the first week were sufficient to determine whether displacement would occur in a majority of patients, making additional radiographic follow-up between weeks 1 and 3 largely unnecessary. 12 However, for fractures with questionable displacement within the first week, follow-up radiographs the following week is reasonable to monitor for potential surgical intervention.…”

Osteosynthesis In Situ for Lateral Condyle Nonunion in Children

“…Repositioning of the fragment anatomically to restore the articular surface often requires extensive soft tissue dissection, which can cause osteonecrosis of the lateral humeral condyle or decreased range of elbow motion after surgery. 9,[11][12][13] Some authors insisted a concept of "Functional reduction," which mobilizes the fragment on a soft tissue pedicle preserving the vascular supply and fixates the fragment not in the anatomic origin but in the position that yields the great range of motion, which seems to be an ideal option, in that it could provide bony union with little risk of osteonecrosis, little loss of elbow motion, and better cosmetics. 4,6,8,14 However, it also carries soft tissue dissection to inevitably accompany the risk of osteonecrosis and it is doubtful whether repositioning of the fracture fragment could improve the range of elbow motion and limb alignment at the same time.…”

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

“…According to the Hardacre criteria 6 patients achieved excellent result and 2 patients with mentioned major complications obtained fair results ( Table 2). end to a good or excellent functional and radiographic result, neglected or lost reduction of displaced LCF of humerus in children can lead to nonunion, cubitus valgus, decreased range of motion and lately presented sign and symptoms of compromised ulnar nerve (2,9).…”