Osteosynthesis In Situ for Lateral Condyle Nonunion in Children

Park, Hoon; Hwang, Jin Ho; Kwon, Yong Uk; Kim, Hyun Woo

doi:10.1097/bpo.0000000000000353

Cited by 25 publications

(16 citation statements)

References 22 publications

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“…Anatomical reduction of the lateral condyle should not be attempted owing to the risk of osteonecrosis and/or elbow stiffness (De Boeck, ; Shimada et al, ). Thus, a residual articular gap resulting in a false “fish tail” deformity of the distal humerus, is accepted as we did in our two cases (De Boeck, ; Flynn, ; Launay et al, ; Park et al, ; Shimada et al, ).…”

Section: Discussionsupporting

confidence: 56%

“…Lateral condyle humeral fractures (LCHF) are the second most common elbow fracture in children, and nonunion is a common complication of LCHF (Flynn, ; Launay et al, ). In situ fixation with a screw and bone grafting is currently the recommended treatment for this chronic injury (Flynn, ; Park, Hwang, Kwon, & Kim, ). An anatomical reduction would result into a high risk of osteonecrosis and chronic elbow stiffness and should be avoided (De Boeck, ; Flynn, ; Launay et al, ; Park et al, ; Shimada, Masada, Tada, & Yamamoto, ).…”

Section: Introductionmentioning

confidence: 99%

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Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

et al. 2017

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

et al. 2017

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“…15,16 Forearm pseudoarthrosis is severely disabling because the dysfunction extends from the elbow to the wrist. [21][22][23][24]…”

Section: Periosteal Vascularized Flaps From the Forearm Anatomymentioning

confidence: 99%

“…It has an optimal size for small defects of up to 4 cm 2 . The length of its pedicle (5.2 cm) allows it to be used both for scaphoid pseudoarthrosis and/or avascular necrosis either by a volar and dorsal approach [17][18][19][20][21][22][23][24][25] . It can also be used for semilunar necrosis or Kienböck disease through a dorsal approach, although 4-5 radial VPFs are often preferred in such cases.…”

Section: Clinical Usefulnessmentioning

confidence: 99%

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Alabau-Rodriguez

Liburd

González

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

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“…Moreover, some anatomic and biologic factors, such as impaired blood supply of the metaphyseal fragment, articular fluid interposition among fragments and traction forces by forearm extensors, as well as surgical pitfalls, such as insufficient reduction or stabilization of the fragment, may retard or prevent fracture healing [10,11]. Despite no evidence-based thresholds for fracture healing have been currently established, it is widely accepted that delayed union is a LHC fracture in which no complete bone healing is observed by more than 8 weeks after the initial injury, while nonunion is defined as no progression of bone healing after 3 months [1,5,[11][12][13]. Delayed union and nonunion of LHC fractures in children account for 2.5% overall, according to a recent systematic review [1].…”

Section: Introductionmentioning

confidence: 99%

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

et al. 2021

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Background: Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial. Methods: Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien–Dindo–Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS). Results: The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), “in-situ” fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2–16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement ≥5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS. Conclusion: Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures.

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Osteosynthesis In Situ for Lateral Condyle Nonunion in Children

Abstract: Level IV - case series.

Cited by 25 publications

References 22 publications

Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

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