Posterolateral approach for humeral lateral condyle fractures in children

Liu, Changheng; Kao, Hsuan-Kai; Lee, Wei-Chun; Yang, Wen-E; Chang, Chia‐Hsieh

doi:10.1097/bpb.0000000000000246

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Although open reduction and internal fixation through a posterolateral approach [ 14 , 34 ] or lateral approach (Kocher approach) [ 3 , 4 , 7 – 10 , 12 ] is the standard treatment for displaced LCFs, [ 13 ] these approaches are not appropriate for visualizing the fracture line on the capitellum (Milch type I LCFs). [ 30 , 31 ] Because the articular surface of the capitellum is present only on the anterior side, only an anterolateral approach permits restoration of joint congruity.…”

Section: Discussionmentioning

confidence: 99%

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Tomori

Nanno²,

Takai³

2018

Medicine

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Rationale:Posteromedial dislocations of the elbow with lateral humeral condylar fractures (LCFs) are uncommon, and only isolated cases have been reported in the English-language literature. Because of the complex radiolucent cartilaginous structures and late-appearing ossification centers, radiological diagnosis of elbow dislocations with LCF in children is challenging.Patient Concerns:We report three children with posteromedial elbow dislocation: two patients with Milch type I and one patient with Milch type II LCF.Diagnoses:In our report, radiographs showed only a small bone fragment, and arthrography or computed tomography were helpful diagnostic aids in cases 1 and 3. In contrast, the patient in case 2 was initially misdiagnosed as having an epiphyseal separation of the distal humerus, and open reduction and internal fixation through the posterior approach revealed Milch type II LCF.Interventions:In case 1 and 3, Milch type I LCFs, open reduction and internal fixation was performed through the posterolateral approach. On the other hand, in case 2, Milch type II LCF, open reduction and internal fixation was performed through the posterior approach.Outcomes:Poor reduction of Milch type I LCFs resulted in incongruity of the articular surface and poor cosmetic results in two patients. In case 2, Milch type II LCF, plain radiographs showed adequate healing without elbow deformity and the clinical result was excellent.Lessons:Because LCFs are intra-articular fractures, anatomical reduction is crucial for satisfactory outcomes. We promote awareness of this injury, especially posteromedial dislocation with Milch type I LCF. Preoperative evaluation is helpful for achieving satisfactory outcomes, and open reduction and internal fixation through an anterolateral approach might be most appropriate for Milch type I LCFs.

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Section: Discussionmentioning

confidence: 99%

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Tomori

Nanno²,

Takai³

2018

Medicine

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“…Because humeral lateral condylar fractures are intra-articular fractures, anatomical reduction of the cartilage of the distal humerus is essential. [ 2 , 3 ] Although the posterolateral approach, [ 5 , 6 ] Kocher approach, to humeral lateral condylar fractures is recommended, this approach does not permit visualizing fractures on the capitellum or the lateral edge of the trochlear groove, which have articular surfaces only on the anterior side (Fig. 4 A).…”

Section: Discussionmentioning

confidence: 99%

“…Lateral condylar fracture lines are classified according to Milch classification [ 4 ] : type I, fracture line lateral to the trochlear groove, and type II, fracture line into the trochlear groove. A posterolateral approach, [ 5 , 6 ] Kocher approach, is recommended for distal humeral lateral condylar fractures. This approach provides good access to the humeral trochlea from the posterior humerus and an optimal approach for open reduction and internal fixation (OR/IF) for lateral condylar fractures with trochlear fractures.…”

Section: Introductionmentioning

confidence: 99%

Anterolateral approach for lateral humeral condylar fractures in children

Tomori¹,

Nanno²,

Takai³

2018

Medicine

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To evaluate the clinical outcomes of an anterolateral approach for lateral humeral condylar fractures in children. The patients aged < 15 years undergoing surgery with an anterolateral approach for humeral lateral condylar fractures between April 2005 and March 2014 were investigated. Medical records and radiographs from 15 patients were reviewed. Average patient age at surgery was 6.0 years (range, 3–10 years). Based on Jakob's classification, 12 patients had type II fractures, and 3 patients had type III fractures. Based on Milch classification, 1 elbow was type I, and 14 elbows were type II. The average postoperative follow-up duration was 16.4 months (range, 6–58 months). Postoperative complications, and radiographic and clinical findings, including range of motion and Flynn criteria were evaluated. To evaluate humeral deformity, Baumann angle (BA) and the carrying angle (CA) were calculated on anteroposterior radiographs. There were no postoperative complications, including secondary displacement, deep infection, nonunion, avascular necrosis, or cubitus varus or valgus deformity. In the injured elbow, follow-up radiographs revealed an average BA of 69.1° (range, 57–84°), versus 70.9° (range, 61–83°) on the contralateral side. The average CA on the injured side was 10.3° (range, 4–20°) versus 12.3° (range, 6–24°) on the contralateral side. BA gain and CA loss (affected- compared with contralateral sides) averaged −1.4° (range, −17° to 9°) and 2.3° (range, −2° to 6°), respectively. The mean range of motion in the affected elbow averaged 4.7° (range, 0–15°) in extension and 139.7° (range, 135–140°) in flexion. Over 5° loss of range of motion in the affected elbow compared with the contralateral side was not observed. However, 2 patients experienced over 5° loss of CA in the affected elbow versus the contralateral side. Based on Flynn criteria, clinical results for both cosmetics and function were excellent in 13 patients, and good in 2. The advantages of the anterolateral approach are combining an optimal view of the anterior articular surface of the trochlea and capitellum and a limited risk of devascularization injury. We strongly recommend an anterolateral approach for these fractures in children to prevent postoperative deformity and to achieve anatomical reduction and reliable fixation.

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Kirschner Wire Fixation with and without Tension Band Wiring for Treatment of Fracture of the Lateral Humeral Condyle in Children

2020

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Background: Kirschner wires (K-wires) are commonly used to treat displaced lateral humeral condyle fracture in children. However, K-wire fixation alone is insufficient for early elbow range of motion (ROM) exercises. Fixation combined with tension band wiring (TBW) converts distraction forces into compression forces, which provides more rigid fixation than K-wire fixation alone. Here, we retrospectively evaluated clinical outcomes of patients with displaced lateral humeral condyle fracture treated with TBW or K-wires only. Methods:We identified children with lateral condyle fractures who had undergone surgery during the period from April 2000 through March 2014. Nineteen patients were classified into 2 groups according to treatment: 10 were allocated to the TBW group (TBW and K-wires) and 9 to the K-wires group. The mean interval from injury to surgery was 5.1 days in both groups. Fractures were classified by using the Jacob's and Milch's classifications. In addition, we collected and analyzed data on postoperative complications, radiological and clinical evaluations, ROM, and Flynn's criteria.Results: Mean duration of follow-up was 14.4 months in the TBW group and 5.9 months in the K-wires group. Mean bone union time was 38.6 days and 49.8 days, respectively. Mean duration of cast/splint use was significantly longer for K-wires patients (49.8 days) than for TBW patients (35.8 days). Range of flexion at the final follow-up was significantly lower in the K-wires group.Conclusions: TBW fixation appears to be the optimal treatment for displaced lateral humeral condyle fracture in children, as it facilitates early active range of motion exercises.(J Nippon Med Sch 2020; 87: 17 23)

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Posterolateral approach for humeral lateral condyle fractures in children

Cited by 4 publications

References 29 publications

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Anterolateral approach for lateral humeral condylar fractures in children

Kirschner Wire Fixation with and without Tension Band Wiring for Treatment of Fracture of the Lateral Humeral Condyle in Children

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