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Rehm A, Newton AC, Hatzantoni K, Linardatou Novak P, Ong JCY, Ashby E. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury 2024; 55:111575. [PMID: 38643617 DOI: 10.1016/j.injury.2024.111575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Paediatric Division Cambridge University Hospitals NHS Foundation Trust Cambridge, United Kingdom.
| | - Ayla C Newton
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust Cambridge, United Kingdom
| | - Katerina Hatzantoni
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust Cambridge, United Kingdom
| | - Pinelopi Linardatou Novak
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust Cambridge, United Kingdom
| | - Joshua C Y Ong
- Department of Paediatric Orthopaedics, Paediatric Division Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics, Paediatric Division Cambridge University Hospitals NHS Foundation Trust Cambridge, United Kingdom
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Adulkasem N, Lewsirirat S, Adulyanukosol V, Sirirungruangsarn Y, Phongprapapan P, Unprasert P, Sukvanich P, Sailohit P, Kulkittaya S, Chotigavanichaya C, Ariyawatkul T, Wongcharoenwatana J, Eamsobhana P. Long-term outcome of nonunion of the lateral humeral condyle fracture in children: a multicentre retrospective study. Int Orthop 2024:10.1007/s00264-024-06180-x. [PMID: 38597940 DOI: 10.1007/s00264-024-06180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Lateral humeral condyle nonunion in children is a rare condition. The treatment protocol for nonunion of lateral humeral condyle remains controversial due to the potential complication. This study reports long-term functional outcomes of the nonunion of the lateral humeral condyle fracture. In addition, we identified the prognostic factors for nonunion of the lateral humeral condyle fracture. METHODS We conducted a multicentre retrospective cohort study of nonunion of lateral humeral condyle between January 1995 and December 2022. The patient's preoperative demographic information was reviewed. Potential risk factors of poor functional outcome, such as age, duration from initial injury, and fracture displacement, were retrieved. Functional outcomes at the latest follow-up visit were evaluated using the Mayo Elbow Performance Score (MEPS). Multivariable linear regression was deployed to evaluate the association of potential risk factors with the functional outcome. RESULTS A total of 63 patients from eight medical centers were included, of which 60 were surgically treated. Patients' average age was 7.3 years old, with a mean follow-up duration of seven years. All nonunion cases were successfully treated, resulting in a normalized humeroulnar angle. The rate of AVN was 16.7%. All patients reported excellent range of motion and MEPS at the latest follow-up. Multivariable linear regression demonstrated that Fracture displacement (β = -0.88, 95% CI -1.55 to -0.22, p = 0.010) and duration from initial injury (β = -0.09, 95% CI -0.17 to -0.02, p = 0.010) were statistically significant factors influencing functional outcome of lateral humeral condyle nonunion. CONCLUSIONS Initial fracture displacement and duration from the initial injury are statistically significantly associated with elbow function in lateral humeral condyle nonunion. However, the effect size for these factors is relatively small and does not reach clinical significance. Despite this, the functional outcome is excellent in all patients, with an average follow-up duration of seven years.
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Affiliation(s)
- Nath Adulkasem
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Supphamard Lewsirirat
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Varinthorn Adulyanukosol
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | | | | | - Pawaris Sukvanich
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Pipattra Sailohit
- Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
| | - Somchai Kulkittaya
- Department of Orthopaedics, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Chatupon Chotigavanichaya
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Thanase Ariyawatkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Jidapa Wongcharoenwatana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Perajit Eamsobhana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Weng L, Zhang G, Zhou H, Liu X, Cao Y, Zhang Y. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury 2024; 55:111309. [PMID: 38199074 DOI: 10.1016/j.injury.2023.111309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Lateral humeral condyle fractures (LHCFs) are the most common intra-articular fracture occurring at the elbow in children. Conventional treatment for displaced pediatric LHCFs is open reduction and percutaneous pinning, and few studies have regarded the efficacy of arthroscopic-assisted techniques. We aimed to evaluate the efficacy of anatomic reduction via elbow arthroscopy for pediatric humeral lateral condyle fractures with displacements >4 mm. METHODS A total of 32 children with LHCFs featuring displacements >4 mm were enrolled in this retrospective study. Arthroscopically assisted reduction was performed as the primary treatment approach. For simple displaced fractures, arthroscopically assisted reduction was directly employed with intermittent intra-articular irrigation. For fractures with distal fragment rotation, the rotated fragments were firstly realigned into a simple displaced position under fluoroscopy before proceeding with arthroscopy. The success rate of arthroscopically assisted reduction and clinical outcomes at the latest follow-up were assessed, and complications related to the procedure were monitored. RESULTS Twenty-nine of 32 (90.62 %) enrolled cases were successfully treated with arthroscopically assisted reduction. Failure cases were attributed to soft tissue swelling, which hindered the manipulation of the fracture fragments for reduction or fixation. We subsequently adapted the surgical procedure, resulting in a significant increase in the success of arthroscopically assisted reduction, rising from 71.43 % to 96 %. Among the 29 successfully treated cases, excellent functional outcomes were observed in 18 cases, and 11 cases showed good outcomes. Regarding the carrying angle outcomes, 28 patients achieved excellent results, with one patient having a good outcome. The most frequent radiographic finding after surgery was lateral spur formation without further negative effects. Only one case of superficial infection occurred, promptly healing with topical management. No significant complications such as neurovascular injury or compartment syndrome were observed. CONCLUSION Arthroscopically assisted anatomic reduction provides a promising alternative to open reduction for LHCFs with displacements exceeding 4 mm, offering direct visualization of the articular surface and minimizing soft tissue dissection.
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Affiliation(s)
- Liuqi Weng
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Ge Zhang
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Hai Zhou
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Xing Liu
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Yujiang Cao
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
| | - Yuan Zhang
- 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, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China.
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Li F, Yang Q, Yi J, Chen A. The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia. J Orthop Surg Res 2023; 18:181. [PMID: 36895031 PMCID: PMC9996921 DOI: 10.1186/s13018-023-03540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To assess in retrospect the effects of brachial plexus block and general anesthesia on children with lateral humeral condyle fractures in terms of postoperative pain and return of upper limb function. METHODS Randomly allocated to either the control group (n = 51) or the study group (n = 55) were children with lateral humeral condyle fractures who were admitted to our hospital between October 2020 and October 2021, depending on the surgical anesthetic technique used. The research group had internal fixation surgery with brachial plexus block in addition to anesthesia on the basis of the control group, whereas both groups of children underwent the procedure with general anesthesia alone. Postoperative pain degree, upper extremity functional recovery, occurrence of adverse reactions, etc. RESULTS: The study group had shorter mean times for surgery, anesthesia, propofol dose, return to consciousness, and extubation than the control group did at every measure of statistical significance. The T2 heart rate (HR) and mean arterial pressure (MAP) were both significantly lower than the pre-anesthesia HR and MAP, and the T1, T2, and T3 HR and MAP were all significantly lower in the study group compared to the control group (P < 0.05). The difference between the SpO2 values at T0 and T3 was not statistically significant (P > 0.05); the VAS scores at 4 h, 12 h, and 48 h after surgery were higher than those at 2 h after surgery, and reached the peak at 4 h after surgery; within 2 h, 4 h, and 12 h of surgery At 48 h, the study group had substantially lower VAS ratings than the control group (P < 0.05). Post-treatment Fugl-Meyer scale scores were considerably higher across the board compared to pre-treatment levels in both groups. When compared to the control group, individuals who participated in the flexion-stretching coordinated exercise and the separation exercise had significantly better ratings. Electrocardiogram, blood pressure, respiratory circulation, and hemodynamic parameters all remained within normal limits during the surgical procedure. The study group had a 9.09% reduced incidence of adverse events compared to the control group. 19.61% (P < 0.05). CONCLUSION When used in conjunction with general anesthesia, brachial plexus block can help children with lateral humeral condyle fractures regulate perioperative signs, maintain their hemodynamic level, lessen postoperative pain and unpleasant reactions, and improve the function of their upper limbs. Functional recovery, with high safety and effectiveness.
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Affiliation(s)
- Fan Li
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Qiao Yang
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Jinrong Yi
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Aiqiong Chen
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China.
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Rehm A, Ong JCY, Ashby E. Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children. J Orthop Surg Res 2022; 17:10. [PMID: 34991652 PMCID: PMC8739715 DOI: 10.1186/s13018-021-02894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andreas Rehm
- Paediatric Division, Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Joshua C Y Ong
- Paediatric Division, Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Elizabeth Ashby
- Paediatric Division, Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Rehm A, Ngu A, Thahir A. The routine cutoff displacement of 2 mm may not reliably reflect the stability of paediatric lateral humeral condyle fractures ✰. Injury 2021; 52:3179-3180. [PMID: 34281691 DOI: 10.1016/j.injury.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/03/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Andreas Rehm
- Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - Albert Ngu
- Higher Orthopaedic Trainee, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Azeem Thahir
- Clinical Fellow, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Soldado F F, Domenech-Fernandez P, Barrera-Ochoa S, Bergua-Domingo JM, Diaz-Gallardo P, Hodgson F, Knorr J. Transverse Anterior Approach to the Elbow for Pediatric Displaced Lateral Humeral Condyle Fractures. Arch Bone Jt Surg 2020; 8:142-146. [PMID: 32490043 DOI: 10.22038/abjs.2019.30756.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a better visualization of the articular fracture resulting in better functional results, less complications and a more cosmetically-appealing scar than usually seen with the lateral approach. Methods Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCF via an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignment and complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level of satisfaction with the cosmetic appearance of the scar. Results Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classified as Jackob's Type II in 14 cases and Milch's type II in all cases. Mean follow-up was 12 (range 4 to19) months.Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operative complications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, active elbow ROM of at least 90%, was obtained. All parents claimed to be "very satisfied" with their child's scar. A lateral spur was identified in 66.7% o patients. Conclusion The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilage reduction. Complications after this technique might decrease compared to the lateral approach but need future comparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage of this approach compared to the classical lateral approach.
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Affiliation(s)
- Francisco Soldado F
- Pediatric Hand Surgery and Microsurgery, UCA Unit, Vithas San Jose, Barcelona, Spain
| | | | - Sergi Barrera-Ochoa
- icat MA Hand and Microsurgery Unit; ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | | | - Paula Diaz-Gallardo
- Pediatric Hand Surgery and Microsurgery, UCA Unit, Vithas San Jose, Barcelona, Spain
| | - Felipe Hodgson
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Knorr
- Pediatric Hand Surgery and Microsurgery, UCA Unit, Vithas San Jose, Barcelona, Spain
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Li XT, Shen XT, Wu X, Chen XL. A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res 2019; 105:557-562. [PMID: 30935813 DOI: 10.1016/j.otsr.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of minimally displaced lateral humeral condyle fractures in pediatric patients is controversial. This is primarily because with current imaging modalities it is difficult to accurately and conveniently determine the stability of the fractures by detecting the integrity of the cartilage hinge. Nevertheless, transverse ultrasonography has not been intensively reported in previous studies. HYPOTHESIS Transverse ultrasonography can determine the integrity of the cartilage hinge in minimally displaced lateral condyle fractures. MATERIALS AND METHODS We retrospectively reviewed the medical records of 39 pediatric patients with minimally displaced fractures of the lateral humeral condyle who underwent transverse ultrasonography between 2014 and 2017. Conservative treatment was given to pediatric patients with intact cartilage hinges that had been confirmed by transverse ultrasound images. Surgical treatment was recommended for pediatric patients with disrupted cartilage hinges. Data regarding healing of the lateral humeral condyle fractures were recorded and analyzed. RESULTS According to transverse ultrasonography, there were 14 children with intact cartilage hinges and 25 children with disrupted cartilage hinges. Fourteen children with intact cartilage hinges of the fracture were treated conservatively, and none of them showed secondary displacement. There were 16 children in whom there was surgical intervention, and 9 other children decided to have conservative treatment among the 25 children with disruption of the cartilage hinge. Five of these 9 children who underwent conservative treatment were found to have further displacement during an average of 12.6 days after the fracture event, and no other patient was found to have further displacement. CONCLUSION Transverse ultrasonography can simply and accurately determine the stability of minimally displaced lateral condyle fractures without sedation, ionizing radiation or invasive techniques. We recommend routine use of transverse ultrasonography to detect stability of the fractures, which can effectively avoid inadequate treatment and unnecessary surgery in pediatric patients with minimally displaced fractures of the lateral humeral condyle. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Xiong-Tao Li
- Wuhan Children's Hospital, Tongji, Medical College, Huazhong University of Science & Technology, Wuhan City, PR China
| | - Xian-Tao Shen
- Wuhan Children's Hospital, Tongji, Medical College, Huazhong University of Science & Technology, Wuhan City, PR China.
| | - Xing Wu
- Wuhan Children's Hospital, Tongji, Medical College, Huazhong University of Science & Technology, Wuhan City, PR China
| | - Xiao-Liang Chen
- Wuhan Children's Hospital, Tongji, Medical College, Huazhong University of Science & Technology, Wuhan City, PR China
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Temporin K, Namba J, Okamoto M, Yamamoto K. Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res 2015; 101:593-6. [PMID: 26143657 DOI: 10.1016/j.otsr.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/18/2015] [Accepted: 04/09/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In minimally displaced pediatric lateral humeral condyle fractures, plain radiography cannot be used for accurate differential diagnosis of the cartilage lesion, and other imaging methods have demerits in their accuracy and their accessibility. The purpose of this study was to investigate the usefulness of arthroscopy to diagnose cartilage displacement in minimally displaced fractures. MATERIALS AND METHODS Nine children with minimally displaced lateral humeral condyle fractures, an average of 6.6 years old, underwent combined arthroscopy and fixation surgery. Percutaneous fixation was performed with nondisplaced articular surface according to the arthroscopic findings, while in case of displaced fracture under arthroscopy, open fixation was preferred. The difference between the arthroscopic and radiographic findings was investigated. RESULTS Articular surface could be arthroscopically visualized in all patients. Under arthroscopy, cartilage hinges were maintained in seven cases and disrupted in two. Nondisplaced cartilage disruption was noted in one of these two cases, and percutaneous fixation was performed. A displaced articular surface was noted in the other one, where the patient underwent open surgery. At the last follow-up, an average of 14.7 months postoperatively, union and wide range of motion had been achieved without any complications. CONCLUSION Diagnosis of fracture displacement by merely using plain radiography was considered to be insufficient for minimally displaced cases. Diagnostic arthroscopy aided in the appropriate selection of either a percutaneous or open fixation method. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- K Temporin
- Department of orthopaedic surgery, Japan Community Health care Organization, Osaka Hospital, 4-2-78 Fukushima, Fukushima-ward, Osaka city, Osaka 5530003, Japan.
| | - J Namba
- Department of orthopaedic surgery, Toyonaka municipal hospital, Toyonaka, Japan
| | - M Okamoto
- Department of orthopaedic surgery, Toyonaka municipal hospital, Toyonaka, Japan
| | - K Yamamoto
- Department of orthopaedic surgery, Toyonaka municipal hospital, Toyonaka, Japan
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