Diagnosis, management and complications of distal humerus lateral condyle fractures in children

Shaerf, Daniel A.; Vanhegan, Ivor; Dattani, Rupen

doi:10.1177/1758573217701107

Cited by 33 publications

(33 citation statements)

References 42 publications

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“…CRPP has shown several advantages over ORIF, including less dissection of soft tissue around the fragment, low risk of vessel damage, low risk of non-union and AVN of distal humerus physes, shorter operating room times, and avoidance of an open incision with unaesthetic scar [ 15 , 19 ], avoidance of another operation or anesthesia because of hardware removal. The present study demonstrated that closed reduction and percutaneous pinning is a safe and efficient technique for treating LCHFs with displacement more than 4 mm, and more than 3/4 of Song stage V or Jakob type III patients can avoid an incision.…”

Section: Discussionmentioning

confidence: 99%

“…However, closed reduction and percutaneous pinning (CRPP) for treating pediatric lateral condylar humerus has been reported only in a few studies [ 9 – 18 ]. CRPP has shown several advantages over ORIF, including less dissection of soft tissue around the fragment, low risk of vessel damage, low risk of non-union and avascular necrosis (AVN) of distal humerus physeal, shorter operating room times, and avoidance of an open incision with an unaesthetic scar [ 15 – 19 ]. In most studies, this technique was used only in cases with displacement between 2 and 4 mm [ 9 , 12 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

Xie¹,

Wang²,

Deng³

et al. 2020

BMC Musculoskelet Disord

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Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon. Results Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

Xie¹,

Wang²,

Deng³

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…CRPP has shown several advantages over ORIF, including less dissection of soft tissue around the fragment, low risk of vessel damage, low risk of non-union and AVN of distal humerus physes, shorter operating room times, and avoidance of an open incision with unaesthetic scar [15,19], avoidance of another operation or anesthesia because of hardware removal. The present study demonstrated that closed reduction and percutaneous pinning is a novel and feasible technique for treating LCHFs with displacement more than 4 mm, and more than 3/4 of Song stage V or Jakob type III patients can avoid an incision.…”

Section: Discussionmentioning

confidence: 99%

“…However, CRPP for treating pediatric lateral condylar humerus has been reported only in a few studies [9][10][11][12][13][14][15][16][17][18]. CRPP has shown several advantages over ORIF, including less dissection of soft tissue around the fragment, low risk of vessel damage, low risk of non-union and avascular necrosis (AVN) of distal humerus physeal, shorter operating room times, and avoidance of an open incision with an unaesthetic scar [15][16][17][18][19]. In most studies, this technique was used only in cases with displacement between 2-4 mm [9,12,15].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning

Xie¹,

Wang

Deng³

et al. 2020

Preprint

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Background: Lateral condylar humerus fractures (LCHFs) are the second most common fractures in children. Open reduction and internal fixation is recommended for fractures displaced by more than 4 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction and fixation are necessary to ensure a fracture gap less than 2.0 mm both on anteroposterior view and oblique internal rotational view by fluoroscopy. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

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“…17 In the past, the main treatment for lateral condylar fractures with non-union was osteotomy surgery to correct elbow valgus deformity. 18 However, osteotomy surgery alone does not address instability of the elbow, and may result in detrimental impact on the patient quality of life. Conversely, the two staged surgery initially manages the stability of the elbow and then focuses on the deformity correction.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children

Liu¹,

Xie²,

Deng³

et al. 2020

Preprint

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Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.

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Diagnosis, management and complications of distal humerus lateral condyle fractures in children

Abstract: We review the diagnosis, evaluation and management of paediatric lateral condylar fractures. The complications of these fractures are also discussed, including the management of fracture non-union.

Cited by 33 publications

References 42 publications

Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning

The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children

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