Fishtail deformity — a delayed complication of distal humeral fractures in children

Narayanan, Srikala; Shailam, Randheer; Grottkau, Brian E.; Nimkin, Katherine

doi:10.1007/s00247-014-3249-9

Cited by 30 publications

(20 citation statements)

References 17 publications

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“…All types of distal humerus fractures in children can lead to this complication regardless of whether the fracture was surgically treated or not 2. Clinical presentation with loss of motion and/or pain is often delayed.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic fishtail deformity of distal humerus—is there a risk for refracture?

Luqman

Kurup

2016

BMJ Case Reports

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We present the case of fishtail deformity of distal humerus in a 13-year-old boy presenting with a refracture 8 years after the original surgically treated lateral condyle fracture. This unusual incomplete vertical fracture of distal humerus starting at the apex of fishtail was treated non-surgically and went on to union but refractured yet again 12 months later. This also went on to full healing with conservative treatment, however the fishtail deformity persists. We discuss the possibility that fishtail deformity reflects an inherent weakness in the distal humerus. We suggest that children and parents should be warned about the potential risk for refracture, particularly if they participate in contact sports.

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Section: Discussionmentioning

confidence: 99%

Post-traumatic fishtail deformity of distal humerus—is there a risk for refracture?

Luqman

Kurup

2016

BMJ Case Reports

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“…Fishtail deformity, an example of posttraumatic osteonecrosis, is the result of a rare delayed complication of distal humerus fractures, which may be supracondylar or condylar, displaced or nondisplaced, or with or without internal fixation (89)(90)(91). Patients typically present with a limited range of motion, pain, and cubitus valgus deformity during late childhood or early adolescence.…”

Section: Posttraumatic Osteonecrosismentioning

confidence: 99%

“…Patients typically present with a limited range of motion, pain, and cubitus valgus deformity during late childhood or early adolescence. Their delayed presentation-on average 5 years after the initial traumatic event (92)-is partially attributed to the late radiographic appearance of the trochlear SOC, which typically occurs when the child is 7-10 years of age (91). Proposed causes include osteonecrosis and longitudinal growth (long bracket).…”

Section: Posttraumatic Osteonecrosismentioning

confidence: 99%

“…MR imaging can be used to delineate the underlying growth plate, evaluate the nonossified trochlear anatomy, detect early osteoarticular findings, and identify the development of osteochondritis dissecans of the capitulum due to increased lateral column loading (91). Symptomatic patients with intra-articular bodies, proximal migration of the forearm, and/or radial head subluxation may require surgical restoration of the joint congruity with arthroplasty, débridement, epiphysiodesis of the adjacent normal growth plate, and/or ulnar nerve transposition (89,91,92).…”

Section: Posttraumatic Osteonecrosismentioning

confidence: 99%

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Imaging of Pediatric Growth Plate Disturbances

et al. 2017

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The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. RSNA, 2017.

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“…This deformity manifests several years after a distal humerus fracture, most commonly after a supracondylar fracture. The proposed mechanism for development of a fishtail deformity is posttraumatic avascular necrosis of the lateral trochlea, because the trochlear ossification center has a precarious blood supply that is vulnerable to injury (43). Injury results in abnormal development of the lateral trochlea, which gives rise to the fishtail-like or chevron-like appearance of the distal humerus (Fig 10).…”

Section: Acute Elbow Injuriesmentioning

confidence: 99%

Imaging the Injured Pediatric Athlete: Upper Extremity

Delgado¹,

Jaramillo²,

Chauvin³

2016

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Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries. Acute injuries are more common in contact sports such as football and wrestling, whereas chronic injuries are often seen in baseball pitchers and gymnasts. Acute injuries unique to pediatric athletes include physeal fractures of the proximal and distal portions of the clavicle (periosteal sleeve fracture), the proximal humeral physis, and the coracoid process, as well as supracondylar, lateral condylar, and medial condylar fractures around the elbow. Chronic injuries, most commonly caused by repetitive microtrauma, include acromial apophyseolysis, Little Leaguer's shoulder, the constellation of findings seen in Little Leaguer's elbow, and injuries to the medial, lateral, and posterior elbow compartments. In addition, trochlear osteochondral lesions, gymnast's wrist, and rock climber's finger are less-common injuries that may be seen in children. In this article, the normal osseous development of the upper extremity is reviewed, with emphasis on the structures that are most commonly injured. The pathophysiology, imaging appearance, and imaging findings of pediatric athletic injuries are described, along with the prognostic implications. RSNA, 2016.

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Fishtail deformity — a delayed complication of distal humeral fractures in children

Abstract: Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.

Cited by 30 publications

References 17 publications

Post-traumatic fishtail deformity of distal humerus—is there a risk for refracture?

Post-traumatic fishtail deformity of distal humerus—is there a risk for refracture?

Imaging of Pediatric Growth Plate Disturbances

Imaging the Injured Pediatric Athlete: Upper Extremity

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