T-condylar humerus fracture in children: treatment options and outcomes

Abstract

Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns.

Treatment of Pediatric Intercondylar Humerus Fracture With External Fixation and Percutaneous Pinning After Closed Reduction

“…There is no available consensus on the treatment of intercondylar fracture of the distal humerus in the pediatric population (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Some surgeons insist that the open reduction and internal fixation is the ideal treatment for a pediatric T-condylar fracture of the humerus, which allows early elbow mobilization preventing stiffness (8,10,15).…”

“…The most common short-term and long-term complications following ORIF are transient neuropathy (16.3%) and elbow stiffness (9.6%), respectively ( 9 ). With the recent trend toward the utilization of a minimally invasive approach in most surgical procedures, closed reduction with external fixation has been reported to provide satisfactory clinical results in pediatric fractures also ( 10 , 11 ). So, most pediatric orthopedic surgeons have the discretion of using the closed method as much as possible.…”

“…The intercondylar fracture of the distal humerus in children is considered to be a rare entity (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Maylahn and Fahey reported an overall incidence of 6 (2%) among 300 elbow injuries in children (10).…”

“…The intercondylar fracture of the distal humerus in children is considered to be a rare entity (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Maylahn and Fahey reported an overall incidence of 6 (2%) among 300 elbow injuries in children (10). In this injury pattern, the medial and lateral condyles are often separated into independent fragments in a "T" or "Y" shape and lose contact with the humeral shaft causing rotational displacement.…”

Central and Eastern Europe actual orthopaedics profile

“…Trauma is represented in this issue by three articles, one article about the fractures of the acetabulum [26], one article about T-condylar humerus fracture in children [27] and the last about lateral tibial plateau fractures-functional outcomes and complications after open reduction and internal fixation [28].…”