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He B, Zhao H, Nan G. Trapezoidal Osteotomy for Treatment of Long-Standing Nonunion of Lateral Humeral Condyle Fracture With Cubitus Valgus Deformity. J Hand Surg Am 2024; 49:931.e1-931.e6. [PMID: 36681538 DOI: 10.1016/j.jhsa.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Long-term nonunion of the lateral humerus condyle fracture may lead to progressive cubitus valgus, elbow pain and instability, and secondary ulnar neuritis. A number of techniques of osteotomy are available for correction, but each has its disadvantages. The aim of this study was to present a technique of medial trapezoidal osteotomy for correcting nonunion of the lateral humeral condyle with an elbow valgus deformity >20°. METHODS Eight patients (mean age, 7.5 years) with cubitus valgus, after neglected nonunion of a lateral humeral condyle fracture of greater than 2 years duration, were treated with trapezoidal combined osteotomy. The mean interval from the lateral condylar fracture to surgery was 3.1 years. The osteotomy lines were marked on the bone with a template made before surgery. The lateral condyle and osteotomy site were fixed with K-wires, and the elbow joint was immobilized in a plaster brace. Pre- and postoperative carrying angles, range of motion, elbow function, and ulnar nerve neuropathy were analyzed. RESULTS The mean follow-up was 5.9 years. Union of the lateral condyle was achieved in all patients; 3 healed at 8 weeks, 2 healed at 9 weeks, 2 healed at 10 weeks, and 1 healed at 12 weeks. The mean carrying angle decreased from 30.1° before surgery to 5.8° after surgery. The surgery did not reduce the range of motion at the elbow. According to the Mayo Elbow Performance Score, 6 patients had excellent elbow function, and 2 had good elbow function at the last follow-up. All preoperative ulnar nerve symptoms resolved. One patient had a mild surgical site infection. No other complications occurred. CONCLUSIONS Medial trapezoidal osteotomy appears to be an effective method for treating nonunion of lateral humeral epicondyle fracture with cubitus valgus deformity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Bo He
- Department of Orthopaedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hai Zhao
- Department of Orthopaedics of Chenzhou No.1 People's Hospital, Hu Nan City, China
| | - Guoxin Nan
- Department of Orthopaedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Masci G, Basiglini L, Giusti C, Aulisa AG, Falciglia F. Lateral Humeral Condyle Fracture in Childhood: Results of a New Surgical Technique. J Clin Med 2024; 13:2830. [PMID: 38792372 PMCID: PMC11122216 DOI: 10.3390/jcm13102830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Fractures of the lateral condyle of the humerus are one of the most common fractures in children, accounting for between 10% and 20% of fractures involving the elbow, with a peak incidence at 6 years of age. Treatment is often surgical for displaced fractures > 2 mm, according to Milch and Jakob classification. There is no consensus in the literature about the appropriate surgical management of these fractures. Objectives: The aim of this study is to describe, propose, and evaluate outcomes and complications of the surgical technique of reduction and osteosynthesis using trans-bone suture with resorbable threads. Methods: Patients with lateral condyle fractures treated with this surgical technique from 2015 to 2019 were included in this retrospective study, with a minimum follow-up of 24 months. For clinical and functional assessment of the elbow, Mayo Elbow Scores were recorded; we assessed the time of fracture healing, carrying angles, and Baumann angle of the affected limb compared to the healthy contralateral elbow for radiographic data. Complications have also been described. Results: We achieved satisfactory results; 36 patients with lateral condyle fractures were included in this study. Radiological healing was achieved in all cases. There was only one complication. No cases required additional surgical procedures. Almost all patients achieved a complete flexion of 110 degrees or more and complete extension. Conclusions: This surgical technique has good functional outcomes and fracture healing, a lower incidence of complications when compared to other surgical techniques, and no mechanical failure with good clinical and radiological results.
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Affiliation(s)
- Giulia Masci
- U.O.C of Orthopedics and Traumatology, Bambino Gesù Children Hospital, IRCSS (Istituto di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy; (G.M.); (C.G.); (A.G.A.); (F.F.)
| | - Luca Basiglini
- U.O.C of Orthopedics and Traumatology, Bambino Gesù Children Hospital, IRCSS (Istituto di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy; (G.M.); (C.G.); (A.G.A.); (F.F.)
| | - Carlotta Giusti
- U.O.C of Orthopedics and Traumatology, Bambino Gesù Children Hospital, IRCSS (Istituto di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy; (G.M.); (C.G.); (A.G.A.); (F.F.)
| | - Angelo Gabriele Aulisa
- U.O.C of Orthopedics and Traumatology, Bambino Gesù Children Hospital, IRCSS (Istituto di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy; (G.M.); (C.G.); (A.G.A.); (F.F.)
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Francesco Falciglia
- U.O.C of Orthopedics and Traumatology, Bambino Gesù Children Hospital, IRCSS (Istituto di Ricovero e Cura a Carattere Scientifico), 00165 Rome, Italy; (G.M.); (C.G.); (A.G.A.); (F.F.)
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Fadel MH, Hashem MH, Ramy A. Correction of cubitus valgus and reconstruction of lateral humerus condylar defect using tricortical iliac graft in pediatric patients. SICOT J 2023; 9:33. [PMID: 38032264 PMCID: PMC10688257 DOI: 10.1051/sicotj/2023028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Neglected non-united lateral humeral condyle fractures in pediatrics are a probable cause of cubitus valgus deformity which is a disabling complication. The ideal management for this condition is still debatable. This study aimed to evaluate the reconstruction of a non-united lateral humerus condylar fracture complicated by cubitus valgus using a tricortical iliac crest graft in pediatric patients. PATIENTS AND METHODS Twenty children suffering from cubitus valgus as a complication after a non-united fracture of the lateral humeral condyle were included in this study. They were managed by open reduction, screw fixation, and reconstruction by an autologous tricortical iliac bone graft. We compared the preoperative and postoperative range of motion of the elbow, alignment, and elbow function using the Mayo elbow performance index. RESULTS There was a statistically significant improvement in the elbow range of motion postoperatively, and there was a highly significant improvement regarding the elbow alignment and function. CONCLUSION Open reduction, screw fixation, and reconstruction by the autologous tricortical iliac bone graft is an effective technique for the management of cubitus valgus due to neglected non-united lateral humeral condyle fractures in pediatrics.
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Affiliation(s)
- Mohamed Hussein Fadel
- Department of Orthopedic Surgery, Faculty of Medicine, Helwan University Cairo Egypt
| | - Mohamed Hassan Hashem
- Department of Orthopedic Surgery, Faculty of Medicine, Helwan University Cairo Egypt
| | - Ahmed Ramy
- Department of Orthopedic Surgery, Faculty of Medicine, Helwan University Cairo Egypt
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Garcia-Rueda MF, Mendoza-Pulido C, Taborda-Aitken JC, Becerra G, Velasquez-Urrego JL, Rincón-Lozano JD, Caicedo-Gutierrez ML, Silva-Amaro AC, Lorza-Toquica LD, Rodriguez-Lopez JA, Salazar-Sierra JA, Saravia-Hoyos GA, Schuster-Wasserman JA, Valencia-Chamorro MP. Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia. Injury 2023; 54 Suppl 6:110780. [PMID: 38143128 DOI: 10.1016/j.injury.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE Level III - retrospective cohort study.
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Affiliation(s)
| | - Camilo Mendoza-Pulido
- School of Medicine, Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia, Carrera 45 #26-85, Bogotá, Colombia
| | - Juan Carlos Taborda-Aitken
- School of Medicine, Department Orthopedics and Traumatology, Universidad Javeriana, Carrera 7 #40-62, Bogotá, Colombia
| | - Gustavo Becerra
- School of Medicine, Universidad Militar Nueva Granada, Carrera 11 #101-80 Bogotá, Colombia
| | | | - Julián David Rincón-Lozano
- Department of Orthopedics and Traumatology, Instituto Roosevelt, Carrera 4 east #17-50, Bogotá, Colombia
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孙 锡, 马 海, 刘 方, 管 之, 张 思, 孙 军. [Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type Ⅱ lateral condylar humerus fractures in children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:952-957. [PMID: 37586794 PMCID: PMC10435339 DOI: 10.7507/1002-1892.202305017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/18/2023]
Abstract
Objective To compare the effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ lateral condylar humerus fracture (LCHF) in children. Methods A clinical data of 101 children with Jakob type Ⅱ LCHF, who met the selection criteria and were admitted between April 2021 and April 2022, was retrospectively analyzed. Of them, 47 cases were treated with ultrasound-assisted Kirschner wire fixation (group A), and 54 cases with arthrography-assisted surgery (group B). There was no significant difference in gender, age, cause of injury, fracture side, and disease duration between groups (P>0.05). Intraoperative fluoroscopy times, operation time, and hospital stay, Flynn elbow joint function score, and postoperative complications were recorded and compared between groups. X-ray examination was performed to observe the healing of fracture, and measure the carrying angle and the shaft-condylar angle (SCA). Results The success rate of closed reduction was significantly higher in group A than in group B (P<0.05), and the intraoperative fluoroscopy times was significantly less in group A than in group B (P<0.05). There was no significant difference in operation time and hospital stay between groups (P>0.05). All children in both groups were followed up 12-18 months, with an average of 13.6 months. X-ray reexamination showed that the fractures of both groups healed, and the difference in healing time was not significant (P>0.05). At last follow-up, there was no significant difference in carrying angle and SCA between unaffected side and affected side in both groups and between groups A and B in affected side (P>0.05). There was no significant difference in Flynn elbow joint function score between groups (P>0.05). There were 18 cases of lateral spurs formation in group A, 1 case of pinning infection and 26 cases of lateral spurs formation in group B, and there was no significant difference in the incidence of the above complications (P>0.05). Conclusion Compared with the arthrography, the ultrasound-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ LCHF in children can avoid the open reduction and decrease the number of intraoperative fluoroscopy, and obtain the good effectiveness.
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Affiliation(s)
- 锡玮 孙
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
- 安徽医科大学第五临床医学院(合肥 230061)The Fifth Clinical College of Anhui Medical University, Hefei Anhui, 230061, P. R. China
| | - 海龙 马
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 方 刘
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 之也 管
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 思成 张
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
| | - 军 孙
- 安徽省儿童医院骨科(合肥 230061)Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China
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Meng C, Meng Z, Huang X, Zhao F, Yang Q. A meta-analysis of closed reduction percutaneous pinning and open reduction with pin fixation of pediatric humeral lateral condylar fracture. Front Pediatr 2023; 11:1205755. [PMID: 37456567 PMCID: PMC10347534 DOI: 10.3389/fped.2023.1205755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To compare the effectiveness and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation to treat the pediatric humeral lateral condylar fracture. Methods Studies comparing closed reduction percutaneous pinning vs. open reduction with pin fixation for treating pediatric lateral humeral condyle fractures were found by searching Pubmed, Embase, the Cochrane Library, and Web of Science databases, including randomized/non-randomized controlled, retrospective case-control, and prospective cohort studies. Furthermore, quality evaluation and data retrieval were conducted after the literature review. A meta-analysis was performed using RevMan 5.4 software to compare both groups' outcome measures. Results This Meta-analysis incorporated eight studies with 856 cases. The Meta-analysis found no significant difference in functional outcomes, superficial infection, deep infection, poor fracture union, avascular necrosis of the humeral capitulum, or lateral spur formation between groups. However, the status of unaesthetic scars in the closed reduction percutaneous pinning group was superior. Conclusions For pediatric humeral lateral condylar fracture surgical therapy, the efficacy and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation were not significantly different; closed reduction percutaneous pinning offered the benefit of eliminating unaesthetic scar. However, further high-quality research is required to verify the conclusions of this Meta-analysis. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023392451.
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Affiliation(s)
- Chao Meng
- Department of Pediatric Surgery, The Affiliated Tengzhou Central People’s Hospital of Xuzhou Medical University, Tengzhou, China
| | - Zhen Meng
- Department of Quality Control, Tengzhou Hospital of Traditional Chinese Medicine, Tengzhou, China
| | - Xin Huang
- Department of Pediatric Surgery, The Affiliated Tengzhou Central People’s Hospital of Xuzhou Medical University, Tengzhou, China
| | - Fenghua Zhao
- Department of Pediatric Surgery, The Affiliated Tengzhou Central People’s Hospital of Xuzhou Medical University, Tengzhou, China
| | - Qun Yang
- Department of Infectious Diseases, The Affiliated Tengzhou Central People’s Hospital of Xuzhou Medical University, Tengzhou, China
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Kim K, Yoon C, Lee HY. Cubitus varus after pediatric lateral condylar fracture: true or pseudo? BMC Musculoskelet Disord 2023; 24:483. [PMID: 37312048 DOI: 10.1186/s12891-023-06604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Common complications of lateral condylar fractures are lateral condylar overgrowth, lateral bony spur and cubitus varus. Lateral condylar overgrowth or lateral bony spur may appear as cubitus varus on gross examination. Such gross cubitus varus without actual angulation is pseudo-cubitus varus, while a difference of more than 5° in varus angulation on X-ray is true cubitus varus. This study aimed to compare true and pseudo-cubitus varus. METHODS One hundred ninety-two children treated for unilateral lateral condylar fracture with a follow-up period of over six months were included. The Baumann angle, humerus-elbow-wrist angle and interepicondylar width of both side were compared. More than 5° in varus angulation on X-ray was considered cubitus varus. Increase in interepicondylar width was considered lateral condylar overgrowth or a lateral bony spur. The risk factors that could predict the development of a true cubitus varus were analyzed. RESULTS True cubitus varus was 32.8%, measured by Baumann angle and 29.2%, measured by humerus-elbow-wrist angle. A total of 94.8% of patients showed an increased interepicondylar width. The predicted cut-off value for 5° varus angulation on the Baumann angle was a 3.675 mm increase in interepicondylar width by ROC curve analysis. The risk of cubitus varus in stage 3, 4, and 5 fractures according to Song's classification was 2.88 times higher than that in stage 1 and 2 fractures on multivariable logistic regression analysis. CONCLUSION Pseudo-cubitus varus is more prevalent than true cubitus varus. A 3.7 mm increase in interepicondylar width could simply predict true cubitus varus. The risk of cubitus varus increased in Song's classification stages 3, 4, and 5.
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Affiliation(s)
- Kyungil Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Chiyoung Yoon
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Yong Lee
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Saris TFF, Eygendaal D, The B, Colaris JW, van Bergen CJA. Lateral Humeral Condyle Fractures in Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1033. [PMID: 37371265 DOI: 10.3390/children10061033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Lateral humeral condyle fractures are frequently seen in pediatric patients and have a high risk of unfavorable outcomes. A fall on the outstretched arm with supination of the forearm is the most common trauma mechanism. A physical examination combined with additional imaging will confirm the diagnosis. Several classifications have been described to categorize these fractures based on location and comminution. Treatment options depend on the severity of the fracture and consist of immobilization in a cast, closed reduction with percutaneous fixation, and open reduction with fixation. These fractures can lead to notable complications such as lateral condyle overgrowth, surgical site infection, pin tract infections, stiffness resulting in decreased range of motion, cubitus valgus deformities, 'fishtail' deformities, malunion, non-union, avascular necrosis, and premature epiphyseal fusion. Adequate follow-up is therefore warranted.
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Affiliation(s)
- Tim F F Saris
- Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands
| | - Joost W Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
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Mehrolhassani Y, Karbalaee Aghazadeh L, Oveisee M. Concurrent ulnar plastic deformity and ipsilateral humeral condylar fracture: A case report. Int J Surg Case Rep 2023; 106:108294. [PMID: 37150163 DOI: 10.1016/j.ijscr.2023.108294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Plastic deformities usually occur in skeletally immature bones not completely ossified due to longitudinal forces on their distal ends, especially the forearm and lower legs. Pediatric lateral humeral condylar fractures (LHCFs) constitute the second most common intra-articular fracture in the upper extremity. Nevertheless, plastic deformities accompanied by other traumatic injuries, including LHCFs, are atypical and rare. This study presents an exceedingly rare case of the concurrence of a plastic deformity and an ipsilateral fracture of the lateral condyle of the humerus in a 6-year-old Persian boy. CASE PRESENTATION The 6-year-old Persian injured boy referred to orthopedic clinic with an obvious deformity in the right upper limb with a limited motion range in the ipsilateral elbow. The patient underwent open-fixation surgery for LHCF fixation and suitable maneuvers to rectify the ulnar plastic deformity. Our findings indicated an acceptable outcome for this approach. His injured limb was reformed without deformities, and the complete union of the fractured area was accomplished eight weeks after surgery. CLINICAL DISCUSSION The case is remarkable as reminding that we have to care concomitant "minor" injuries to the main fracture and to correctly treat them. Furthermore, open fixation surgery for LHCF rectification before fixing the ulnar deformity with the aid of a suitable maneuver led to good outcome and acceptable rehabilitation in a case of concurrent ulnar plastic deformity and an ipsilateral fracture of the external condyle of the humerus. CONCLUSION Our approach helps to avoid further tissue damage and prevent the 2-stage surgical process.
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Affiliation(s)
| | | | - Maziar Oveisee
- Orthopedic Department, School of Medicine, Bam University of Medical Sciences, Bam, Iran; Clinical Research Center, Pastor Educational Hospital, Bam University of Medical Sciences, Bam, Iran.
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Wang B, Gao R, Li Z, Guo Z, Ji Z, Li W, Sun K. Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study. J Orthop Surg Res 2023; 18:139. [PMID: 36829228 PMCID: PMC9951476 DOI: 10.1186/s13018-023-03619-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical and functional outcomes of early versus delayed treatment of pediatric lateral condylar fractures of the humerus with a displacement greater than 2 mm. METHODS Sixty-seven children treated surgically at our hospital from March 2016 to September 2021 for lateral condylar fracture of the humerus with displacement > 2 mm were retrospectively analyzed. The children were divided into two groups where early surgery consisted of patients being operated on within 24-h post-injury (n = 36) and delayed surgery consisted of children operated after 24-h post-injury (n = 31). Clinical and functional results were compared between the two groups. RESULTS There were no significant differences between the two groups in terms of operation time, blood loss and incidences of perioperative complications. However, mean length of incision was significantly greater (P < 0.0001) in the delayed treatment group (5.68 ± 1.08 cm) compared to the early treatment group (3.89 ± 0.82 cm). No differences were found in functional outcomes, consisting of the Baumann angle of the affected limb, the carrying angle, Mayo Elbow Performance Score, and Flynn's criteria at final follow-up. CONCLUSIONS Delay in surgery for more than 24 h after injury does not influence the clinical and functional results for lateral condylar fracture of the humerus with displacement > 2 mm in children. However, delayed open reduction and pinning may increase the incision length possibly due to increased edema.
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Affiliation(s)
- Biao Wang
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Rongxuan Gao
- grid.411609.b0000 0004 1758 4735Department of Orthopaedics, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhenwei Li
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Zhanhao Guo
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Zejuan Ji
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Weili Li
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Keming Sun
- Department of Orthopaedics, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.
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Liu Y, Shi W, Zhao H, Li Y, Li J, Xun F, Canavese F, Xu H. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. INTERNATIONAL ORTHOPAEDICS 2022; 46:2291-2297. [PMID: 35723700 DOI: 10.1007/s00264-022-05476-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF). METHODS This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12 months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients. Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria. RESULTS Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7 months (range, 12.3-40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5 min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40 s, respectively; p < 0.001). Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09). CONCLUSIONS CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.
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Affiliation(s)
- Yanhan Liu
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Weizhe Shi
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Hai Zhao
- Department of Pediatric Orthopedics, Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
| | - Yiqiang Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Jingchun Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Fuxin Xun
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Av. Eugene Avinée, 59000, Lille, France
| | - Hongwen Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China.
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Impacts of Fracture Types on Success Rate of Closed Reduction and Percutaneous Pinning in Pediatric Lateral Condyle Humerus Fractures Displaced >4 mm. J Pediatr Orthop 2022; 42:265-272. [PMID: 35180724 DOI: 10.1097/bpo.0000000000002093] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed reduction and percutaneous pinning (CRPP) is a promising treatment for pediatric lateral condyle humerus fractures (LCHFs) displaced >4 mm. However, few studies discussed roles of fracture types on success of CRPP in LCHFs. This study aimed to analyze the impacts of types of LCHFs displaced >4 mm on the success rate of CRPP. METHODS We retrospectively reviewed 66 consecutive pediatric LCHFs attempted CRPP at our center. Song, Milch, Jakob, and Weiss classification were used to classify LCHFs. The fracture gap ≤2 mm and step of articular surface ≤2 mm were deemed as a successful CRPP. Otherwise, open reduction and internal fixation (ORIF) would be performed. Different fracture types and preoperative displacement were analyzed for their roles on success rate of CRPP in treating LCHFs displaced >4 mm. RESULTS Fifty patients met the inclusion criteria were finally included in this study. Results showed that Milch type II LCHFs had a higher success rate of CRPP than type I LCHFs (P=0.03, <0.05). Correlation was found between Milch types and success rate of CRPP displaced >4 mm. No difference was found between Song stage 4 and 5 LCHFs displaced >4 mm in success rate of CRPP (P=0.90, >0.05), also no difference was found in pre-operative displacement between CRPP group and ORIF group. CONCLUSIONS Milch classification is more important than Song classification in the success rate of CRPP when treating LCHFs displaced >4 mm. Milch type II LCHFs are recommended to be treated with CRPP, while Milch type I LCHFs are recommended to be treated with ORIF. The current study confirm Song's initial report that closed reduction can be successful and should be attempted for fractures with such displacement rather than going directly to ORIF. LEVEL OF EVIDENCE Level III.
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Swarup I, Chan C, Mehta N, Lawrence JT. Does an elbow arthrogram change management after closed reduction of mildly displaced lateral condyle fractures in children? J Pediatr Orthop B 2022; 31:7-11. [PMID: 32991375 DOI: 10.1097/bpb.0000000000000811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate whether an elbow arthrogram after closed reduction and percutaneous fixation of lateral condyle fractures results in a change in surgical management. This is a retrospective review of lateral condyle fractures managed with closed reduction and percutaneous fixation followed by an elbow arthrogram at our institution between 2008 and 2019. Chart and radiographic review was performed and operative notes were reviewed to determine rates of subsequent intervention after arthrogram. Descriptive statistics were used to summarize the data. This study included 47 patients. The majority of patients were male (34 patients, 72%), and the mean age at time of injury was 5.5 ± 2.6 years. The mean radiographic displacement was 2.6 mm (range 0.8-6.9 mm). All fractures were managed by fellowship-trained pediatric orthopaedic surgeons with an average of 10.5 years of experience (range 0-32 years). Fractures were stabilized with percutaneous pins in 44 patients (94%) and percutaneous screws in three patients (6%). No patients had subsequent changes in management after an elbow arthrogram. There were no complications related to performance of the arthrogram. Closed reduction and percutaneous fixation is often indicated for mildly displaced lateral condyle fractures. Articular reduction after percutaneous fixation is commonly assessed using an elbow arthrogram; however, it did not change surgical management in any case reviewed over the 10-year study period. While there seems to be little risk of performing an arthrogram, the clinical utility should be further evaluated.
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Affiliation(s)
- Ishaan Swarup
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Calvin Chan
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nishank Mehta
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John T Lawrence
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
- Division of Pediatric Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by > 4 mm: an observational cross-sectional study. BMC Musculoskelet Disord 2021; 22:985. [PMID: 34823533 PMCID: PMC8620550 DOI: 10.1186/s12891-021-04880-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although open reduction and internal fixation (ORIF) is recommended for lateral condylar humerus fractures (LCHFs) displaced by > 4 mm, several studies have reported the use of closed reduction and percutaneous pinning (CRPP) to treat LCHFs with significant displacement. However, little is known about the clinical differences between these two surgical techniques. This study aimed to compare the therapeutic effects of CRPP and ORIF in treating LCHFs displaced by > 4 mm. METHODS We retrospectively reviewed pediatric LCHFs displaced by > 4 mm treated with either CRPP or ORIF at our center from June 2019 to October 2020. Song and Milch fracture classifications were used. Variables such as age at injury, sex, side injured, fracture displacement, fracture type, operating time, postoperative treatment, and complications were compared between the two techniques. RESULTS One hundred twenty LCHFs met inclusion criteria. There were 36 Milch type I and 84 type II LCHFs, and 69 Song stage 4 and 51 stage 5 LCHFs. CRPP was performed in 45 cases and ORIF in 75 cases. No differences were found in age, sex, side injured, preoperative displacement, postoperative displacement, and length of immobilization between the CRPP and ORIF groups. There was a difference between operation time and pin duration. The CRPP group had shorter operation times and pin duration, and required no additional operations to remove internal pins. The average follow-up duration was 13.9 months. All patients achieved fracture union, and no complications such as infection, nonunion, delayed union, osteonecrosis, fishtail deformity, cubitus varus or valgus, or pain were recorded during follow-up. Bone spurs, lateral prominences, and decreased carrying angle were common complications in all groups. No obvious cubitus varus was observed. Unaesthetic scars were only observed in the ORIF groups. No differences in range of motion or elbow function was found among the different therapies. CONCLUSIONS Both CRPP and ORIF can achieve satisfactory clinical outcomes in treating LCHFs displaced by > 4 mm. No differences were found in complications or prognoses between the two groups. However, CRPP shows some advantages over ORIF, like less invasive surgery, no obvious scarring, and no need for secondary surgery with anesthesia for pin removal.
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Wendling-Keim DS, Teschemacher S, Dietz HG, Lehner M. Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation? Eur J Pediatr Surg 2021; 31:374-379. [PMID: 32722825 DOI: 10.1055/s-0040-1714656] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The treatment of the displaced fracture of the lateral condyle of the distal humerus in children aims not only to avoid nonunion, malalignment, and impairment of the range of motion of the elbow but also to prevent delayed healing and the development of any prearthrotic deformity. To date there is no agreement on what kind of osteosynthesis should be used. So far, the screw fixation and Kirschner wire fixation have both been applied. Therefore, the goal of this study was to compare the outcome of these two methods. MATERIALS AND METHODS A retrospective cohort study was undertaken including 43 patients aged 2 to 13 years who underwent osteosynthesis for a condylar fracture of the humerus over a period of 10 years. The electronic archive, including the radiological diagnostics, was analyzed. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an α level of p = 0.05. RESULTS Kirschner wire fixation was performed in 48.9% of condylar fractures of the humerus while screw fixation (alone or in combination with a pin) was assessed with a percentage of 51.1% of the cases in this study. Screw fixation only was applied in 20.9% of fractures of the lateral condyle. The selection of the method was independent of the age of the patient (p = 0.2). The comparison of the rate of complications and an impaired range of motion after Kirschner wire osteosynthesis to the rate after screw osteosynthesis showed a significantly lower percentage for the Kirschner wire group (p = 0.046). No case of nonunion, nerve palsy, or pin migration was detected in any patient in this study. CONCLUSION Kirschner wire fixation of condylar humeral fractures in children resulted in a lower rate of complications than screw fixation. No case of nonunion of the fracture was found in the patients that we investigated so that we conclude that Kirschner wires sufficiently adapt the fracture in these cases. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Danielle S Wendling-Keim
- Pediatric Surgery, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Sandra Teschemacher
- Pediatric Surgery, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Hans-Georg Dietz
- Pediatric Surgery, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Markus Lehner
- Department of Pediatric Surgery, Luzerner Kantonsspital Kinderspital Luzern, Luzern, Switzerland
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Kim WJ, Park C, Evans D, Sarraf K. Management of lateral condyle fractures of the humerus in children. Br J Hosp Med (Lond) 2021; 82:1-6. [PMID: 34338018 DOI: 10.12968/hmed.2020.0733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lateral condyle fracture of the humerus is the second most common paediatric elbow fracture and is often missed, which can result in severe consequences including malunion, growth arrest and tardy ulnar nerve palsy. The difficulty in managing this fracture stems from a lack of awareness and the often subtle findings on radiographs. Patients can also present with quite vague symptoms; clinicians who do not have a high index of suspicion may not investigate beyond the initial clinical assessment and could miss vital cues. This article provides a guide to managing this common paediatric fracture, from initial presentation to definitive treatment, and discusses the complications that can ensue if managed incorrectly.
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Affiliation(s)
- Woo Jae Kim
- Department of Surgery, Walsall Healthcare NHS Trust, Walsall, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, UK
| | - Douglas Evans
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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Xiao R, Cirino C, Williams C, Hausman M. Arthroscopy of the Pediatric Elbow: Review of the Current Concepts. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1730394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractAs surgeons have become more familiar with elbow arthroscopy, the indications for arthroscopy of the pediatric elbow have expanded to include contracture releases, fracture fixation, treatment of osteochondritis dissecans (OCD) lesions, correction of elbow deformity, and debridement of soft tissue and bony pathologies. The treatment of various pathologies via an arthroscopic approach demonstrates equal, if not better, efficacy and safety as open surgery for the pediatric elbow. Arthroscopy provides the unique advantage of enabling the performance of extensive surgeries through a minimally-invasive approach, and it facilitates staged interventions in cases of increased complexity. For fracture work, arthroscopy enables direct visualization to assess reduction for percutaneous fixations. While future research is warranted to better evaluate the indications and outcomes of pediatric elbow arthroscopy, this update article presents a review of the current literature, as well as several innovative cases highlighting the potential of arthroscopy.
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Affiliation(s)
- Ryan Xiao
- Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United Sates
| | - Carl Cirino
- Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United Sates
| | - Christine Williams
- Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United Sates
| | - Michael Hausman
- Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United Sates
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Radiological comparison of parallel fixation and divergent fixation using K-wire in pediatric lateral condyle fractures. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.829330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord 2020; 21:707. [PMID: 33109140 PMCID: PMC7592374 DOI: 10.1186/s12891-020-03738-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon. Results Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.
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