Medial humeral condyle fractures in adolescents: treatment and complications

Abstract

The very rare isolated medial humeral condyle fractures in children and adolescents pose significant problems to orthopedic surgeons such as ulnar nerve injury, trochlear irregularities, fishtail deformity and motion loss. Six adolescent boys with displaced medial humeral condyle fractures with an average age of 14.8 (range 12-17) were included in this study. Patients were followed-up with a mean of 39.8 months (range 21-72). In three patients, there were clinical signs of ulnar nerve dysfunction at initial presentation. Of these, two had only mild hypoesthesia on the ulnar side. The other patient had sensory and motor loss of ulnar nerve at initial presentation complicated by hypothenar atrophy and anhydrosis during follow-up. Complete recovery was seen in this patient only at 2 years. One patient without a neurologic compliant at initial presentation developed mild hypoesthesia on the ulnarly innervated areas postoperatively with complete resolution. Medial skin incision was used for open reduction and internal fixation. No signs of gross morphologic damage were seen on the nerve. The symptoms resolved postoperatively in 3 months time in three of the patients, but in the remaining one, it took 2 years for complete resolution of the symptoms. Also, trochlear irregularity and fishtail deformity were seen on radiographs of two different patients. In all but one patients, motion loss ranging from 10° to 20° was evident on physical examination. The most important finding of this study revealed that transient ulnar nerve dysfunction was seen two-thirds of the patients in this series than any other series reported previously. In three series, only one case of ulnar nerve injury was reported from a total of 19 patients. A possible explanation for such a difference may be the older age in this series.

Hegemann's disease and fishtail deformity: Aetiopathogenesis, radiographic appearance and clinical outcome

“…Range of motion was used as the outcome measure in seven studies [ 12 , 14 , 16 , 19 , 21 , 24 , 25 ]. Loss of extension was seen in 12 patients (67 %) [ 12 , 14 , 16 , 21 , 25 ] and a valgus deformity was seen in seven patients (39 %) [ 12 , 14 , 16 , 18 , 24 ]. Clinical symptoms were described in 11 patients [ 13 , 16 , 21 , 24 ].…”

“…Fifteen case reports regarding fishtail deformity including 58 patients were analysed [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The study and patient characteristics are shown in Table 3.…”

“…The average age at injury was 7.8 years (range 2-15 years) [12][13][14][15][16][17][21][22][23][24]. In nine studies, the sex of the patient was noted [12,13,16,17,[20][21][22][23]25]. Most patients were male (74 %).…”

Use of MRI assisting the diagnosis of pediatric medial condyle fractures of the distal humerus

“…Most studies support conservative treatment for Kilfoyle grade I and II fractures, while grade III requires open reduction and internal fixation [ 1 , 2 , 5 , 13 ]. We agree with these previous studies on this point, but we still aggressively favor open reduction concerning complications such as secondary displacement.…”

“…Additionally, similar to the lateral condyle fracture of the humerus, MCFH also requires anatomical reduction because of compromise to the articular surface and epiphysis. Delayed treatment can result in serious consequences such as osteonecrosis and cubitus varus [ 5 – 7 ].…”