Surgical Technique for Closed Reduction and Percutaneous Pinning of Pediatric Lateral Humeral Condyle Fractures

Prusick, Vincent; Dantzker, Nicholas J.; Hysong, Alexander A.; Johnson, Megan E.; Mencio, Gregory A.; Stutz, Christopher M.; Schoenecker, Jonathan G.

doi:10.1097/bto.0000000000000330

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Arthrogram is useful to identify the articular cartilage status. [19] We believe that it guides the surgeons and helps them have a better understanding and visualization of the injury, especially in Grade 2 and 3 patients who are likely to have articular cartilage disturbance. Some studies compared patients managed with and without an arthrogram have not shown a notable difference between both patient groups.…”

Section: Discussionmentioning

confidence: 94%

“…Some studies compared patients managed with and without an arthrogram have not shown a notable difference between both patient groups. [19] Other studies demonstrate that arthrogram helps reduce the need for ORIF and its associated complications, which is itself a valid reason to use arthrogram. [13,20] This study is limited by its small sample size of 16 patients, which may underestimate the difference between Grade 2 and 3 fractures and the rates of AVN.…”

Section: Discussionmentioning

confidence: 98%

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The safety and efficacy of closed reduction and percutaneous pinning with an intraoperative arthrogram for Grade 2 and Grade 3 pediatric lateral condyle fractures

Al-Naseem

Al-Shehawy²,

Khaja³

et al. 2022

JMSR

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Objectives: It is controversial whether pediatric lateral humeral condyle fractures (LHCFs) with >2 mm displacement can be managed using closed reduction and percutaneous pinning (CRPP) as opposed to open reduction. This study assesses the clinical, radiographic outcomes, and complication rates of patients undergoing arthrogram-assisted CRPP for fractures with >2 mm of displacement rather than open reduction and internal fixation. Methods: This study was conducted retrospectively, looking at all children presenting acutely with LHCFs that were displaced >2 mm between January 2017 and December 2019 whom one surgeon treated within 48 hours of the initial injury. Sixteen patients met the inclusion criteria. Pre-operative and post-operative anteroposterior as well as lateral radiographs were used to measure displacement and classify fractures. A subgroup analysis was done to compare the results in Grade 2 and 3 fractures as per Weiss classification. Results: Signs of union were observed in all patients at 2 weeks and all fractures were healing well at 6-week follow-up, regardless of fracture grade or displacement. Post-operative complications including pin site infections, valgus deformity, non-union, or malunion were not seen. A higher proportion of Grade 3 patients developed heterotrophic ossification and limitation of range of movement. Conclusion: Arthrogram imaging is a valuable tool to help visualize the articular cartilage surface and determine the suitability of CRPP for LHCF with >2 mm displacement. It is a safe option with good outcomes and provided that there is no significant articular cartilage incongruity seen under fluoroscopy.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

The safety and efficacy of closed reduction and percutaneous pinning with an intraoperative arthrogram for Grade 2 and Grade 3 pediatric lateral condyle fractures

Al-Naseem

Al-Shehawy²,

Khaja³

et al. 2022

JMSR

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“…These studies did not recommend CRIF for rotated fractures 8,11,12. Other published studies5,7,13,14 showed good results after CRIF for completely displaced and rotated fragments and also stated that there may be no place for ORIF in treatment of a displaced, rotated lateral humeral condyle.…”

Section: Discussionmentioning

confidence: 97%

Comparison of closed and open reduction internal fixation of acutely displaced unstable lateral humeral condylar fractures in children: a prospective cohort study

Kotb

Alagamy

Saleh

2021

Current Orthopaedic Practice

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Background:Lateral humeral condylar fractures in children are considered the second most common type of fractures in pediatric elbows after supracondylar fracture. Conservative treatment of these types of fracture usually fails. Open reduction and internal fixation of these types of fractures has been the treatment of choice with regard to anatomical reduction and stable internal fixation. Complications of open reduction range from mild complications, such as scars of the skin incision, to severe, such as avascular necrosis of the lateral condyle. Closed reduction and percutaneous fixation of the fracture may give the same results as open reduction with regard to reduction and healing of the fracture but without the complications of open reduction. Methods:This prospective interventional study was conducted in 60 patients who had lateral humeral condylar fractures. Patients were grouped into two equal groups: one group was managed by closed reduction and internal fixation (CRIF), and the second group was managed by open reduction and internal fixation (ORIF). Results:The two groups were compared after the operation and 1-year followup. There was no difference between the two groups with regard to fracture healing and complications, with the exception of complications of wound healing and skin scarring after open reduction. Conclusions:Closed reduction and percutaneous pinning of lateral humeral condylar fractures gave the same results in bone healing without the complications of skin-incision healing that were found in open reduction.

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“…An attempt at a closed reduction can be performed utilizing elbow varus and forearm pronation to disengage the fragments followed by supination and elbow valgus. 4 Direct pressure with the surgeon's thumb can improve the reduction (Figures 4-7).…”

Section: Operative Technique or Set-upmentioning

confidence: 99%

Open Reduction and Pinning of Lateral Condyle Fractures

Prusick¹,

Muchow²

2023

Journal of the Pediatric Orthopaedic Society of North America

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Lateral condyle fractures are the second most common elbow fracture in pediatric patients. Unlike supracondylar humerus fractures, these injuries involve the articular surface and present unique challenges. These injuries are graded based on the degree of displacement and this dictates your treatment. Both closed and open techniques are appropriate depending on the degree of displacement. Our preferred technique for open reduction and internal fixation is described and illustrated in the accompanying video. Key Concepts• Lateral condyle fractures are common elbow injuries in the pediatric population affecting the articular surface.• Accurate reduction of articular surface is critical.• In order to promote healing, these fractures often require longer immobilization than supracondylar fractures due to intraarticular nature of the injury.• Blood supply to the capitellum enters posteriorly, so one must be cautious with posterior dissection.

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Surgical Technique for Closed Reduction and Percutaneous Pinning of Pediatric Lateral Humeral Condyle Fractures

Cited by 5 publications

References 8 publications

The safety and efficacy of closed reduction and percutaneous pinning with an intraoperative arthrogram for Grade 2 and Grade 3 pediatric lateral condyle fractures

The safety and efficacy of closed reduction and percutaneous pinning with an intraoperative arthrogram for Grade 2 and Grade 3 pediatric lateral condyle fractures

Comparison of closed and open reduction internal fixation of acutely displaced unstable lateral humeral condylar fractures in children: a prospective cohort study

Open Reduction and Pinning of Lateral Condyle Fractures

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