Management of Neglected Lateral Condyle Fracture of Humerus

Ranjan, Rahul; Sinha, Abhinav; Asif, Naiyer; Ifthekar, Syed; Kumar, Ashish; Chand, Suresh

doi:10.4103/ortho.ijortho_319_16

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…In lateral condylar fractures with no shift or a displacement of less than 2 mm, long arm cast immobilization is effective [1]. However, due to the need to restore the integrity of the articular surface of the distal humerus, internal xation is considered the optimal choice for most displaced lateral condylar fractures [1][2][3][4][5][6][7][8][9]. Due to epiphysis, standard x-ray examination of the lateral elbow does not provide a full, clear view of metaphyseal fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Due to epiphysis, standard x-ray examination of the lateral elbow does not provide a full, clear view of metaphyseal fractures. Therefore, clinicians are unable to properly assess the degree of fracture displacement, leading to possible neglect and misdiagnosis of fractures [2][3][4]. If a fracture is missed, the treatment becomes di cult and bony abnormalities can occur.…”

Section: Discussionmentioning

confidence: 99%

“…Due to epiphyses in children, standard anterior-posterior and lateral x-ray examination of the elbow usually does not fully reveal metaphyseal fractures, sometimes only on the internal oblique view the fracture can be shown [2]. Therefore, clinicians are unable to fully assess the degree of fracture displacement, leading to possible neglect and misdiagnosis of fractures [3,4]. If a lateral condylar fracture is missed, complications can occur, leading to di cult treatment later.…”

Section: Introductionmentioning

confidence: 99%

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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 interval from fracture to the first surgery was 8.2 years on average. 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 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 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…in 2018 [17] suggests that there was no difference in the treatment modalities. However, immobilization time was less in cancellous screw group which is consistent with our study.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children

Afaque¹,

Singh²

2020

Nat. J. Clin. Orthop.

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Introduction: This study compares the outcome of two treatment modalities of fixing neglected lateral condyle fracture of humerus in children in terms of clinical and radiological outcomes. Materials and Methods: All patients presenting to our institution were screened for eligibility by clinico-radiological evaluation. Patients were randomized into two groups i.e. Cancellous screw (CS) fixation (group I) and K wire fixation (group II). Patients were treated by open reduction and internal fixation using CS or K wires of appropriate size accordingly. (21 patients in group I and 19 patients in group II). Bone graft was used in all patients to promote osteosynthesis. Average follow up of patients was 18 months (range 11-22 months). Final outcome was measured in terms of clinicoradiological union, immobilization time, loss of reduction, gain in range of motion and functional outcome measured by Liverpool elbow score. Result: 21 patients were in group I (CS) and 19 patients were in group II (K wire). Mean age for group I and II was 7.9 and 7.5 years. Mean delay in presentation for group I and II was 14.9 and 13.2 weeks. Mean gain in range of motion (at final follow up as compared preoperatively) for group I and II was 23.5 and 17.8. Mean duration of immobilization for group I and II was 11.3 and 9.6 weeks. Mean LES score was 8.7 and 8.3 in group I and II. Union was seen in 37 cases. Three patients had pre mature physeal closure. Pin tract infection was seen in 4 patients in group II which healed by dressing and antibiotics. No patient had ulnar nerve palsy. Conclusion: Both techniques provide stable fixation, union and good functional outcome and there was no difference in the LES, however less immobilization and improvement in range of motion was seen in Group I (CS)

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“…There is also a wide variation about the choice of fixation-with k-wires and screw-wire combination being the common two methods used. Ranjan et al in 2018 were the first to compare these two methods of fixation for neglected fractures [29]. Though they found that the functional scores to be statistically similar in both the methods, the period of immobilization was significantly higher in k-wires as compared to CC screws.…”

Section: Fixation Methodsmentioning

confidence: 99%

Neglected Lateral condyle Humerus Fractures: Current Concepts and Practices

2021

IJPO

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Neglected lateral condyle fractures present varied and difficult challenges to the treating orthopaedic surgeon. They have the potential to cause long term problems like deformities, stiffness, instability and tardy ulnar nerve palsy. The treatment of lateral condyle non-unions depend on the presence or absence of deformity, the duration of non-union, skeletal maturity of the child and the presence or absence of ulnar nerve palsy. Accordingly the treatment ranges from conservative management in neglected fractures with no deformity and no ulnar nerve palsy at one end, Open/mini-open or closed in-situ fixation for established non-unions with instability and corrective osteotomy with fixation of non-union and ulnar nerve transposition at the other end. In this article, the authors have endeavoured to go through the various aspects of clinical presentations and treatment modalities for this difficult fracture. Keywords: Neglected lateral condyle fractures, Cubitus valgus, Tardy ulnar nerve palsy, Instability.

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Management of Neglected Lateral Condyle Fracture of Humerus

Cited by 8 publications

References 22 publications

The effect of staged surgical treatment for cubitus valgus after non-union of lateral condylar fracture of distal humerus in older children

The effect of staged surgical treatment for cubitus valgus after non-union of lateral condylar fracture of distal humerus in older children

Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children

Neglected Lateral condyle Humerus Fractures: Current Concepts and Practices

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