Deformity after Fracture of the Lateral Humeral Condyle in Children

Abstract

We studied 28 displaced (Jacob types II and III) fractures of the lateral humeral condyle in 28 children. There were only two Milch type I fractures. Twenty-one fractures were treated by open reduction and internal fixation with K-wires, Palmer nails, or sutures. Seven patients were treated with a plaster cast, five following closed reduction, and the primary displaced position being accepted in two. Anatomic reduction was obtained in 18 patients. All but one fracture were united at review 2 years to 16 years later. The distal humerus was wider on the injured side in all patients. Six patients had a visible varus deformity, and three patients had a visible valgus deformity. The radiologic tilt of the joint surface and the depth of the trochlear groove were measured in patients more than 10 years old at review. All patients with a final varus tilt of the joint surface on the injured side were less than 9 years of age at injury, and all but one of the patients with Milch type II fractures had a deepening of the trochlear groove. Two patients developed avascular necrosis of the trochlea. One of these had a concomitant fracture of the medial humeral epicondyle, and the other suffered a lateral condylar fracture preceded by a supracondylar fracture. We conclude that a reduced growth potential at the trochlear groove is a regular complication of the Milch type II fracture, and that the Jacobs classification is the most useful in the assessment of the method of treatment.

Intra‐Observer and Inter‐Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience

“…Fractures around the elbow are among the most common points of fracture in children. These fractures are important because of pathophysiological defects in this area leading to nonunions, neurovascular complications, deformities, and limitation of children's activities. For this reason, the recognition of injuries is essential.…”

The “floating forearm” injury in a child: a case report

“…Disruption of osseous and or articular stabilisers dramatically increases the risk of redislocation and recurrent instability [6, 12, 13]. As even simple dislocation of the paediatric elbow or single-column injuries of either the lateral or medial epicondyle are reported to lead to both deformity and loss of function [4, 5, 11, 16], in a case of multidirectional instability after sufficient restoration of the ligaments and bony components a hinged external fixator is of great value to provide stability and early mobilisation [8, 9, 14, 17]. Hinged external fixators rely on accurate placement of the hinge co-linear with the axis of rotation of the joint [7, 12].…”

Pictorial review: ‘Fishtail deformity’ of the elbow

“…Fishtail deformity has been described as a complication of any fracture around the elbow in childhood, except an epicondylar fracture. It most commonly follows a supracondylar fracture, 4 but has also been described following lateral condylar fractures, 1,3 medial condylar fractures 2 and Salter Harris 1 epiphyseal fractures 1 . The patient's age at the time of the fracture has been reported to range from 13 months to 13 years old.…”

“…There remains controversy regarding the aetiology of fishtail deformity. Inadequate fracture reduction, 7,10 growth plate injury with premature growth plate fusion 2,11 and vascular causes 1,3,12 have previously been hypothesised. The current literature increasingly points towards a vascular aetiology, with the primary problem being that of an avascular necrosis of the lateral aspect of the trochlea 6 …”

“…Fishtail deformity of the elbow is a rare complication that can follow a wide range of elbow fractures in childhood. Whilst this deformity has been well described in the paediatric orthopaedic literature, 1–5 it has only recently been described in the radiology literature 6 . We present a number of cases of fishtail deformity, discuss the imaging findings, the proposed aetiology and the potential complications of this deformity.…”