The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically

Volume 7 | Issue 2 | May-August 2021 | Page: 12-16 | Anil Agarwal, Prateek Rastogi

Authors: Anil Agarwal [1], Prateek Rastogi[2]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
[2] Department of Orthopedics, Sharda Medical College, Greater Noida, Uttar Pradesh, India.

Address of Correspondence
Dr. Anil Agarwal
4/103, East End Apartments, Mayur Vihar Ph-1 Ext., Delhi-110096, India.
E-mail: rachna_anila@yahoo.co.in

Abstract

Background
We graphically analyzed the correction of total Pirani and Dimeglio scores and their subcomponents at sequential casting sessions for children with idiopathic clubfeet.
Methods
Correction of scores at weekly sessions was represented graphically. The tenotomy effect was accounted for separately. We classified 1st to 3rd casts as early, 4th and 5th cast midlevel, and beyond 5 as final casts to describe casting treatment.
Results
A total of 88 clubfeet (34 bilateral) in 54 patients were studied. Both total Pirani and Dimeglio graphs were characterized by a steep fall in early casts; subsequent minimal improvement in midlevel and final casts; later marked correction with tenotomy. Equinus in both scores stood as the most resistant deformity, showed full correction only following tenotomy. Dimeglio graphs captured coupling of various foot motions better over early casts than Pirani graphs.
Conclusions
Both Pirani and Dimeglio scores can adequately guide caregivers to progressive deformity correction in clubfoot.
Keywords: Clubfoot, CTEV, Pirani, Dimeglio, Scores, Graphs

References

1. Staheli L. Clubfoot: Ponseti management. Seattle, WA: Global HELP; 2009.
2. Pirani S, Naddumba E, Staheli L. Ponseti Clubfoot management: Teaching manual for healthcare providers in Uganda. Seattle, WA: Global HELP; 2008.
3. Chaudhry S, Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B. 2012;21: 73-78.
4. Lampasi M, Trisolino G, Abati CN, Bosco A, Marchesini Reggiani L, Racano C, et al. Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score. Int Orthop. 2016;40:2199-2205.
5. Lampasi M, Abati CN, Stilli S, Trisolino G. Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: are we coming to the same decisions? J Orthop Surg (Hong Kong). 2017;25:2309499017713916
6. Agarwal A, Shanker M. Temporal variation of scores along the course of the Ponseti treatment in older children: A ready guide to progress of treatment. J Pediatr Orthop. 2020;40:246-250.
7. Pirani S, Outerbridge HK, Sawatzki B, et al. A reliable method of clinically evaluating a virgin clubfoot evaluation. In: Proceedings of the 21st SICOT World Congress, Sydney, Australia, 18-23 April 1999.
8. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4:129-136.

How to Cite this Article:  Agarwal A, Rastogi P | The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 12-16.

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Should we Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 07-11 | Teixeira R, Ovídio J, Arcangelo J, Campagnolo J, Tavares D

Authors: Teixeira R [1], Ovídio J [2], Arcangelo J [2], Campagnolo J [2], Tavares D [2]

[1] Hospital São Francisco Xavier, Lisbon, Portugal.
[2] Hospital Dona Estefânia, Lisbon, Portugal

Address of Correspondence
Dr. Raquel Teixeira,
Rua dos Quartéis 80, r/c direito, 1300-483 Ajuda, Lisbon, Portugal.
E-mail: rt.corda@gmail.com

Abstract

Objective: The association between clubfoot and developmental dysplasia of the hip (DDH) remains uncertain, with only a few studies linking both. However, clubfoot is considered as a risk factor for DDH. The aim of this study was to determine the incidence of DDH and evaluate the need for routine hip imaging in our population of children with clubfoot.
Methods: Retrospective analysis of all patients treated for clubfoot in our center between 2010 and 2019. We included patients with hip imaging for DDH in the first 12 months of life.
Results: There were 108 children with clubfoot who underwent DDH screening. 92 had idiopathic clubfoot and 16 had syndromic clubfoot. Of the patients with idiopathic clubfoot, 2 (2.2%) had DDH; one had a clinically unstable hip and the other patient underwent hip screening on account of the clubfoot alone. Among patients with syndromic clubfoot, 3 (18.8%) had developmental dysplasia of the hip. Two of them had an abnormal hip examination while the other had normal hip clinical examination but other established risk factors for DDH.
Conclusion: A targeted ultrasound or radiological screening programme for DDH in idiopathic clubfoot diagnosed hip dysplasia in only 1 child that would have otherwise been missed by clinical examination alone. We conclude that hip imaging is not warranted in children with idiopathic clubfoot and regular clinical screening may suffice. In syndromic clubfoot, due to the higher incidence of DDH, we recommend specific ultrasound screening even in the presence of a normal hip examination.
Keywords: Clubfoot, Screening, Developmental dysplasia of the hip.

References

1. Westberry DE, Davids JR, Pugh LI. Clubfoot and developmental dysplasia of the hip: Value of screening hip radiographs in children with clubfoot. J Pediatr Orthop. 2003;23(4):503-507.
2. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146-1153.
3. Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: A systematic review. J Orthop Surg Res. 2018;13(1):1-11.
4. Silva C, Costa G. Importância da ecografia no rastreio e diagnóstico precoce da displasia do desenvolvimento da anca. Rev Port Ortop e Traumatol. 2013;21(2):147-163.
5. Chou DTS, Ramachandran M. Prevalence of developmental dysplasia of the hip in children with clubfoot. J Child Orthop. 2013;7(4):263-267.
6. French, L; Dietz F. Screening for developmental dysplasia of the hip. Am Fam Physician. 1999;60(1):177-184.
7. Gurnett CA, Boehm S, Connolly A, Reimschisel T, Dobbs MB. Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Med Child Neurol. 2008;50(7):498-502.
8. Sadler B, Gurnett CA, Dobbs MB. The genetics of isolated and syndromic clubfoot. J Child Orthop. 2019;13(3):238-244.
9. Werler MM, Yazdy MM, Mitchell AA, et al. Descriptive epidemiology of idiopathic clubfoot. Am J Med Genet Part A. 2013;161(7):1569-1578.
10. Mahan, Susan; Yazdy, Mahsa; Kasser, James; Werler M. Is it worthwhile to routinely ultrasound screen children with idiopathic clubfoot for hip dysplasia? J Pediatr Orthop. 2013;33(8).
11. Ömeroğlu H, Akceylan A, Köse N. Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: A retrospective case control study. J Child Orthop. 2019;13(2):161-166.
12. D’Alessandro M, Dow K. Investigating the need for routine ultrasound screening to detect developmental dysplasia of the hip in infants born with breech presentation. Paediatr Child Heal. 2019;24(2):E88-E93. d
13. Perry DC, Tawfiq SM, Roche A, et al. The association between clubfoot and developmental dysplasia of the hip. J Bone Jt Surg – Ser B. 2010;92 B(11):1586-1588.
14. Gomes S, Antunes S, Diamantino C, et al. Displasia de desenvolvimento da anca: seis anos de rastreio ecográfico a crianças de risco. Nascer e Crescer – Rev do Hosp Crianças Maria Pia. 2012;21(4):226-229.
15. Calonge N, Allan JD, Berg AO, et al. Screening for developmental dysplasia of the hip: Recommendation statement – US Preventive Services Task Force. Pediatrics. 2006;117(3):898-902.
16. Vaquero-Picado A, González-Morán G, Garay EG, Moraleda L. Developmental dysplasia of the hip: Update of management. EFORT Open Rev. 2019;4(9):548-556.
17. The H. Screening for the detection of congenital dislocation of the hip. Arch Dis Child. 1987;62(3):315-316.
18. Santos, L; Fonseca M. Protocolo de rastreio de displasia de desenvolvimento da anca (DDA). 2012
19. Wynne-Davies R, Littlejohn A, Gormley J. Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). J Med Genet. 1982;19(5):321-328.
20. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-96.

How to Cite this Article:  Teixeira R, Ovídio J, Arcangelo J, Campagnolo J, Tavares D | Should We Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 07-11.

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Iliopsoas Abscess in Children – A Forgotten Diagnosis

Volume 7 | Issue 2 | May-August 2021 | Page: 17-19 | Vinod Raj, Abhishek Chinya, Sanjay Sardessai, Jeevan Vernekar

Authors: Vinod Raj [1], Abhishek Chinya [1], Sanjay Sardessai [2], Jeevan Vernekar [2]

[1] Department of Paediatric Surgery, Goa Medical College and Hospital, Goa, India.
[2] Department of Radiology, Goa Medical College and Hospital, Goa, India

Address of Correspondence
Dr. Vinod Raj
Department of Paediatric Surgery, Goa Medical College and Hospital, NH 17, Bambolim, Tiswadi, North Goa,
Goa, India. 403202
E-mail: doc.vraj89@gmail.com

Abstract

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases.
Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

References

  1. Cronin CG, Lohan DG, Meehan CP, Delappe E, McLoughlin R, O’Sullivan GJ, et al. Anatomy, pathology, imaging and intervention of the iliopsoas muscle revisited. Vol. 15, Emergency Radiology. 2008. p. 295–310.
  2. Wong-Chung J, Bagali M, Kaneker S. Physical signs in pyomyositis presenting as a painful hip in children: A case report and review of the literature. Vol. 13, Journal of Pediatric Orthopaedics Part B. 2004. p. 211–3.
  3. Wang E, Ma L, Edmonds EW, Zhao Q, Zhang L, Ji S. Psoas abscess with associated septic arthritis of the hip in infants. J Pediatr Surg. 2010 Dec;45(12):2440–3.
  4. Elliott C. Paediatric Iliopsoas abscess: A case report. Australas J Ultrasound Med. 2013 Nov;16(4):198–201.
  5. Dietrich A, Vaccarezza H, Vaccaro CA. Iliopsoas abscess: Presentation, management, and outcomes. Surg Laparosc Endosc Percutaneous Tech. 2013 Feb;23(1):45–8.
  6. López VN, Ramos JM, Meseguer V, Pérez Arellano JL, Serrano R, Ordonez MAG, et al. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore). 2009 Mar;88(2):120–30.
  7. Zhou Y, Li G. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Chinese J Infect Chemother. 2010 Jul 20;10(4):241–7.
How to Cite this Article:  Raj V, Chinya A, Sardessai S, Vernekar J | Iliopsoas Abscess  in Children – A Forgotten Diagnosis | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 17-19.

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Neglected Lateral Condyle Humerus Fractures: Current Concepts and Practices

Volume 7 | Issue 2 | May-August 2021 | Page: 35-41 | Mandar Agashe, Premal Naik

Authors: Mandar Agashe [1], Premal Naik [2]

[1] Department of Orthopaedic, Dr Agashe Maternity & Surgical Nursing Home, Mumbai, Maharashtra, India.
[2] Department of Orthopaedic, Rainbow Super Speciality & Children Orthopaedic Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Mandar Agashe
Paediatric Orthopaedic Surgeon, Dr Agashe Maternity & Surgical Nursing Home, Mumbai, Maharashtra, India.
E-mail: mandarortho@gmail.com

Abstract

Neglected lateral condyle fractures present varied and difficult challenges to the treating orthopaedic surgeon. They have the potential to cause long term problems like deformities, stiffness, instability and tardy ulnar nerve palsy. The treatment of lateral condyle non-unions depend on the presence or absence of deformity, the duration of non-union, skeletal maturity of the child and the presence or absence of ulnar nerve palsy. Accordingly the treatment ranges from conservative management in neglected fractures with no deformity and no ulnar nerve palsy at one end, Open/mini-open or closed in-situ fixation for established non-unions with instability and corrective osteotomy with fixation of non-union and ulnar nerve transposition at the other end. In this article, the authors have endeavoured to go through the various aspects of clinical presentations and treatment modalities for this difficult fracture.
Keywords: Neglected lateral condyle fractures, Cubitus valgus, Tardy ulnar nerve palsy, Instability.

References

1. Kumar N, Meena S, Mehtani A, Yadav C, Raj R, Barwar N. Delayed presentation of fracture of lateral condyle of humerus in pediatric age group treated by ORIF and ulnar peg grafting: A case series. J Orthop Allied Sci. 2015;3(1):12. doi:10.4103/2319-2585.155911.
2. Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Harata S. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg Am. 2002;84(4):593-598. doi:10.2106/00004623-200204000-00013.
3. Tan SHS, Dartnell J, Lim AKS, Hui JH. Paediatric lateral condyle fractures: a systematic review. Arch Orthop Trauma Surg. 2018;138(6):809-817. doi:10.1007/s00402-018-2920-2.
4. Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand. 1986;57(4):309-312. doi:10.3109/17453678608994398.
5. Masada K, Kawai H, Kawabata H, Masatomi T, Tsuyuguchi Y, Yamamoto K. Osteosynthesis for old, established non-union of the lateral condyle of the humerus. J Bone Joint Surg Am. 1990;72(1):32-40.
6. Prakash J, Mehtani A. Open reduction versus in-situ fixation of neglected lateral condyle fractures: A comparative study. J Pediatr Orthop Part B. 2018;27(2):134-141. doi:10.1097/BPB.0000000000000443.
7. Song KS, Shin YW, Oh CW, Bae KC, Cho CH. Closed reduction and internal fixation of completely displaced and rotated lateral condyle fractures of the humerus in children. J Orthop Trauma. 2010;24(7):434-438. doi:10.1097/BOT.0b013e3181de014f.
8. Ramo BA, Funk SS, Elliott ME, Jo C-H. The Song Classification Is Reliable and Guides Prognosis and Treatment for Pediatric Lateral Condyle Fractures: An Independent Validation Study With Treatment Algorithm. J Pediatr Orthop. 2020;40(3):e203-e209. doi:10.1097/BPO.0000000000001439.
9. Cates RA, Mehlman CT. Growth arrest of the capitellar physis after displaced lateral condyle fractures in children. J Pediatr Orthop. 2012;32(8):e57-62. doi:10.1097/BPO.0b013e31826bb0d5.
10. Jakob R, Fowles JV, Rang M KM. Observations concerning fractures of the lateral humeral condyle in children. J Bone Jt surgery, Br. 1975;57(4):430-436. https://pubmed.ncbi.nlm.nih.gov/1104630/.
11. Eamsobhana P, Kaewpornsawan K. Should we repair nonunion of the lateral humeral condyle in children? Int Orthop. 2015;39(8):1579-1585. doi:10.1007/s00264-015-2805-8.
12. Agarwal A, Qureshi NA, Gupta N, Verma I, Pandey DK. Management of neglected lateral condyle fractures of humerus in children: A retrospective study. Indian J Orthop. 2012;46(6):698-704. doi:10.4103/0019-5413.104221
13. Chhetri RS, Dhakal I, Gnawali G. Operative Management of Late Presented Displaced Lateral Condyle Fracture of Humerus in Children. JNMA J Nepal Med Assoc. 2018;56(209):527-530.
14. Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988;59(4):419-424. doi:10.3109/17453678809149395.
15. Flynn JC, Richards JFJ. Non-union of minimally displaced fractures of the lateral condyle of the humerus in children. J Bone Joint Surg Am. 1971;53(6):1096-1101.
16. Shrestha S, Hutchison RL. Outcomes for late presenting lateral condyle fractures of the humerus in children: A case series. J Clin Orthop trauma. 2020;11(2):251-258. doi:10.1016/j.jcot.2019.09.012.
17. Trisolino G, Antonioli D, Gallone G, et al. Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition? Child (Basel, Switzerland). 2021;8(1). doi:10.3390/children8010056.
18. Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Narita S. Osteosynthesis for nonunion of the lateral humeral condyle. Clin Orthop Relat Res. 2002;(405):230-241. doi:10.1097/00003086-200212000-00030.
19. Lagrange J, Rigault P. [Treatment of supra-condylar fractures of the humerus in children]. Presse Med. 1970;78(53):2382.
20. AD S, AD T, AW S, HD I, H S, AD R. Delayed Operative Management of Fractures of the Lateral Condyle of the Humerus in Children. Malaysian Orthop J. 2015;9(1):18-22. doi:10.5704/moj.1503.010
21. JEFFERY CC. Non-union of the epiphysis of the lateral condyle of the humerus. J Bone Joint Surg Br. 1958;40-B(3):396-405. doi:10.1302/0301-620X.40B3.396.
22. Miyake J, Shimada K, Masatomi T. Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults. J Shoulder Elb Surg. 2010;19(7):958-964. doi:10.1016/j.jse.2010.03.002.
23. Shimada K, Masada K, Tada K, Yamamoto T. Osteosynthesis for the treatment of non-union of the lateral humeral condyle in children. J Bone Joint Surg Am. 1997 Feb;79(2):234-40. doi: 10.2106/00004623-199702000-00011. PMID: 9052545.
24. Knight DM, Alves C, Alman B, Howard A. Percutaneous screw fixation promotes healing of lateral condyle nonunion in children. J Pediatr Orthop. 2014;34(2):155-160. doi:10.1097/BPO.0000000000000077.
25. Morris S, McKenna J, Cassidy N, Stephens M. A new technique for treatment of a non-union of a lateral humeral condyle. Injury. 2000;31(7):557-559. doi:10.1016/s0020-1383(00)00033-4.
26. Park DY, Cho JH, Lee D-H, Choi W-S, Bang JY, Yin XY. A 3-Dimensional Analysis of the Fracture Planes in Pediatric Lateral Humeral Condyle Fractures for Image-Based Pin Positioning During Fixation. J Orthop Trauma. 2017;31(10):e340-e346. doi:10.1097/BOT.0000000000000914.
27. Mohan N, Hunter JB, Colton CL. The posterolateral approach to the distal humerus for open reduction and internal fixation of fractures of the lateral condyle in children. J Bone Joint Surg Br. 2000;82(5):643-645. doi:10.1302/0301-620x.82b5.10435.
28. Ibrahim MA, Ismail MSAM. Corrective osteotomy and in situ fusion for late-presenting nonunion of lateral condyle fractures of the humerus in adults. J Shoulder Elb Surg. 2019;28(3):520-524. doi:10.1016/j.jse.2018.08.005.
29. Ranjan R, Sinha A, Asif N, Ifthekar S, Kumar A, Chand S. Management of Neglected Lateral Condyle Fracture of Humerus: A Comparison between Two Modalities of Fixation. Indian J Orthop. 2018;52(4):423-429. doi:10.4103/ortho.IJOrtho_319_16.
30. Tien YC, Chen JC, Fu YC, Chih TT, Huang PJ, Wang GJ. Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children. Surgical technique. J Bone Joint Surg Am 2006 Sep;88 Suppl 1 Pt 2:191-201.
31. Abed Y, Nour K, Kandil YR, El-Negery A. Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series. Int Orthop. 2018 Feb;42(2):375-384. doi: 10.1007/s00264-017-3709-6. Epub 2017 Dec 6.
32. Roye, David P. Jr. M.D.; Bini, Stefano A. M.D.; Infosino, Andrew M.D. Late Surgical Treatment of Lateral Condylar Fractures in Children, Journal of Pediatric orthopaedics: March 1991 – Volume 11 – Issue 2 – p 195-199.

 

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How to Cite this Article:  Agashe M, Naik P. | Neglected Lateral Condyle Humerus  Fractures: Current Concepts and Practices | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 35-41.

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ABCD of Lateral Condyle Humerus Fracture in Children: Anatomy, Biomechanics, Classification and Diagnosis

Volume 7 | Issue 2 | May-August 2021 | Page: 24-29 | Taral V Nagda, Avi Shah, Dhwanil Tada

Authors: Taral V Nagda [1], Avi Shah [1], Dhwanil Tada [1]

[1] Department of Orthopaedics, SRCC NH Childrens Hospital, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Taral Nagda,
Consultant Paediatric Orthopaedic Surgeon, SRCC NH Children’s Hospital, Mumbai, Maharashtra, India.
E-mail: taralnagda@gmail.com

Abstract

The lateral condyle fractures which form less than 20% of paediatric elbow fractures are seen at average 6 years age and have less severity of signs and symptoms which may lead to delayed diagnosis. Internal rotation view of X-ray of elbow is important in addition to standard AP and Lateral views. Jakob, Weiss and Song are commonly used classification systems in decision making.

Keywords: Lateral condyle fracture, Children, Classification, Anatomy, Diagnosis.

Further Reading

1. Abzug JM, Dua K, Kozin SH, Herman MJ. Current concepts in the treatment of lateral condyle fractures in children. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020 Jan 1;28(1):e9-19.
2. Baker M, Borland M. Range of elbow movement as a predictor of bony injury in children. Emergency Medicine Journal. 2011 Aug 1;28(8):666-9.
3. Finnbogason T, Karlsson G, Lindberg L, Mortensson W. Nondisplaced and minimally displaced fractures of the lateral humeral condyle in children: a prospective radiographic investigation of fracture stability. J Pediatr Orthop. 1995;15:422–5.
4. Flynn JC, Richards JF, Saltzman RI. Prevention and treatment of non-union of slightly displaced fractures of the lateral humeral condyle in children. An end-result study. J Bone Jt Surg Am.1975;57:1087–92.
5. Herman MJ, Boardman MJ, Hoover JR, Chafetz RS. Relationship of the anterior humeral line to the capitellar ossific nucleus: variability with age. JBJS. 2009 Sep 1;91(9):2188-93
6. Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6:312–5. https ://doi.org/10.1007/s0077 61006 0312.
7. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Jt Surg Br. 1975;57:430–6.
8. Landin LA, Danielsson LG. Elbow fractures in children. Anepidemiological analysis of 589 cases. Acta Orthop Scand. 1986;57:309–12.
9. Pressmar J, Weber B, Kalbitz M. Different classifications concerning fractures of the lateral humeral condyle in children. European Journal of Trauma and Emergency Surgery. 2020 Apr 23:1-7.
10. Ramo BA, Funk SS, Elliott ME, Jo CH. The Song classification is reliable and guides prognosis and treatment for pediatric lateral condyle fractures: an independent validation study with treatment algorithm. Journal of Pediatric Orthopaedics. 2020 Mar 1;40(3):e203-9.
11. Schroeder K, Gilbert S, Ellington M, Souder C, Yang S. Pediatric Lateral Humeral Condyle Fractures. JPOSNA. 2020 May 3;2(1).
12. Song KS, Kang CH, Min BW, Bae KC, Cho CH, Lee JH. Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. JBJS. 2008 Dec 1;90(12):2673-81.
13. Song KS, Kang CH, Min BW, Bae KC, Cho CH. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. JBJS. 2007 Jan 1;89(1):58-63.
14. Song KS, Waters PM. Lateral condylar humerus fractures: which ones should we fix? Journal of Pediatric Orthopaedics. 2012 Jun 1;32:S5-9.
15. Tan SH, Dartnell J, Lim AK, Hui JH. Paediatric lateral condyle fractures: a systematic review. Archives of Orthopaedic and Trauma Surgery. 2018 Jun 1;138(6):809-17.
16. Tan SHS, Dartnell J, Lim AKS, Hui JH. Paediatric lateral condyle fractures: A systematic review. Arch Orthop Trauma Surg. 2018;138(6):809–17.
17. Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediar Orthop. 2009 Sep 1;29(6):602-5.

 

 

How to Cite this Article:  Nagda TV, Shah A, Tada D | ABCD of Lateral Condyle Humerus Fracture in Children: Anatomy, Biomechanics, Classification and Diagnosis | International Journal of Paediatric
Orthopaedics | May-August 2021; 7(2): 24-29.

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Complications of Lateral Humeral Condyle Fractures in Children

Volume 7 | Issue 2 | May-August 2021 | Page: 42-47 | Vikas Basa, Avi Shah, Shital N Parikh

Authors: Vikas Basa [1], Avi Shah [2], Shital N Parikh [3]

[1] Department of Orthopaedics, Kokilaben Dhirubhai Ambani Hospital and Medical Institute Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, SRCC Childrens Hospital, Mumbai, Maharashtra, India.
[3] Department of Orthopaedic Surgery, Cincinnati Children’s Hospital, Burnet Av, Cincinnati, OH.

Address of Correspondence
Dr. Shital N Parikh,
Professor of Orthopaedic Surgery, Cincinnati Children’s Hospital 3333. Burnet Av Cincinnati, OH. 45229.
E-mail: Shital.parikh@cchmc.org

Abstract

Lateral humeral condyle fractures in children are easily missed and often associated with complications. These complications include malunion, delayed union or nonunion, lateral spur formation, fishtail deformity and growth disturbances. There is also controversy related to best treatment options including closed vs open reduction and K-wire vs screw fixation. Though some complications like malunion are avoidable, others like lateral spur formation are inevitable. Knowledge about these complications would help in counseling patients and their families. The purpose of this article was to review common complications related to these fractures and suggest tips to avoid some of them.
Keywords: Paediatric, Lateral condyle fracture, Internal oblique X-ray, Arthrogram, Anatomical reduction, Complications, Tips to overcome

References

1. Bhandari M, Tornetta P and Swiontkowksi MF The Evidence-Based Orthopaedic Trauma Working Group. Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma 2003; 17: 306-308.
2. Hardacre JA, Nahigian SH, Froimson AI and Brown JE. Fractures of the lateral condyle of the humerus in children. J Bone Joint Surg (Am) 1971; 53: 1083–1095.
3.Flynn JC: Nonunion of slightly displaced fractures of the lateral humeral condyle in children: An update. J Pediatr Orthop 1989;9(6):691-696
4. Song KS, Kang CH, Min BW, Bae KC and Cho CH. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am 2007; 89: 58–63.
5. Jakob R, Fowles JV, Rang M and Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg (Br) 1975; 57: 430–436.
6. Weiss JM, Graves S, Yang S, et al. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop. 2009;29: 602–605.
7. Schroeder K, Gilbert S, Ellington M, Souder C, Yang S. Pediatric Lateral Humeral Condyle Fractures. JPOSNA. 2020 May 3;2(1).
8. Skak SV, Olsen SD, Smaabrekke A: Deformity after fracture of the lateral humeral condyle in children. J Pediatr Orthop B 2001; 10:142-152.
9. Rutherford A: Fractures of the lateral humeral condyle in children. J Bone Joint Surg (Am) 1985;67(6):851-856
10. Badelon O, Bensahel H, Mazda K, Vie P: Lateral humeral condylar fractures in children: A report of 47 cases. J Pediatr Orthop 1988;8(1):31-34.
11. So YC, Fang D, Leong JC, Bong SC: Varus deformity following lateral humeral condylar fractures in children. J Pediatr Orthop 1985;5(5):569-572.
12. Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg. 2011; 19:350–358
13. Tan SH, Dartnell J, Lim AK, Hui JH. Paediatric lateral condyle fractures: a systematic review. Arch Ortho Trauma Surgery. 2018 Jun 1;138(6):809-17.
14. Wirmer J, Kruppa C, Fitze G. Operative treatment of lateral humeral condyle fractures in children. Eur J Pediatr Surg 2012: 22(4):289–294
15. Bauer AS, Bae DS, Brustowicz KA, Waters PM. Intra-articular corrective osteotomy of humeral lateral condyle malunions in children: early clinical and radiographic results. J Pediatr Orthop. 2013 Jan 1;33(1):20-5.
16. Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988; 59:419–424
17. Beaty JH, Kasser JR. Rockwood & Wilkens fractures in children. 7th ed. Philadelphia. Wolters Kluwer /Lippincott Williams and Wilkens; 2010
18. Wadsworth TG. Injuries of the capitular (lateral humeral condylar) epiphysis. Clin Orthop Relat Res. 1972; 85:127–142.
19. Cates RA, Mehlman CT. Growth arrest of the capitellar physis after displaced lateral condyle fractures in children. J Pediatr Orthop. 2012 Dec 1;32(8): e57-62.
20. Sinikumpu, J-J, Pokka, T, Victorzon, S, et al.: Paediatric lateral humeral condylar fracture outcomes at twelve years’ follow-up as compared with age and sex matched paired controls. Int Orthop 2017; 41:1453–1461.
21. Papandrea R, Waters PM. Posttraumatic reconstruction of the elbow in the pediatric patient. Clin Orthop Relat Res. 2000; 370:115-26.
22. Mader K, Koslowsky TC, Gausepohl T, Pennig D. Mechanical distraction for the treatment of posttraumatic stiffness of the elbow in children and adolescents: surgical technique. J Bone Joint Surg. 2007 Mar 1;89(2_suppl_1):26-35.
23. Salgueiro L, Roocroft JH, Bastrom TP, Edmonds EW, Pennock AT, Upasani VV, Yaszay B. Rate and risk factors for delayed healing following surgical treatment of lateral condyle humerus fractures in children. J Pediatr Orthop. 2017 Jan 1;37(1):1-6.
24. Abzug JM, Dua K, Kozin SH, Herman MJ. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg. 2020 Jan 1;28(1): e9-19.
25. Pribaz JR, Bernthal NM, Wong TC, Silva M: Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop 2012; 32:456-460.
26. Leonidou A, Chettiar K, Graham S, et al: Open reduction internal fixation of lateral humeral condyle fractures in children: A series of 105 fractures from a single institution. Strateg Trauma Lim Reconstr. 2014; 9:73-78.
27. Shirley E, Anderson M, Neal K, Mazur J: Screw fixation of lateral condyle fractures: Results of treatment. J Pediatr Orthop 2015; 35:821-824.
28. Li WC, Xu RJ: Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Int Orthop 2012; 36:1261-1266.
29. Narayanan S, Shailam R, Grottkau BE, Nimkin K: Fishtail deformity: A delayed complication of distal humeral fractures in children. Pediatr Radiol 2015;45: 814-819.
30. Glotzbecker MP, Bae DS, Links AC, Waters PM. Fishtail deformity of the distal humerus: a report of 15 cases. J Pediatr Orthop. 2013 Sep 1;33(6):592-7.
31. Hasler CC, von Laer L Prevention of growth disturbances after fractures of the lateral humeral condyle in children. J Pediatr Orthop B 2001: 10(2):123–130
32. Foster DE, Sullivan JA, Gross RH Lateral humeral condylar fractures in children. J Pediatr Orthop 1985: 5(1):16–22
33. Gilbert SR, MacLennan PA, Schlitz RS, Estes AR. Screw versus pin fixation with open reduction of pediatric lateral condyle fractures. J Pediatr Orthop B. 2016 Mar 1;25(2):148-52.
34. Stein BE, Ramji AF, Hassanzadeh H, Wohlgemut JM, Ain MC, Sponseller PD. Cannulated lag screw fixation of displaced lateral humeral condyle fractures is associated with lower rates of open reduction and infection than pin fixation. J Pediatr Orthop. 2017 Jan 1;37(1):7-13.
35. Birkett N, Al-Tawil K, Montgomery A. Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review. Orthop Res Rev. 2020 Mar 6; 12:45-52.
36. 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 . 2020 Jul 28.
37. Qin YF, Li ZJ, Li CK, Bai SC, Li H. Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures: A meta-analysis. Medicine. 2017 Aug;96(34).
38. Ormsby NM, Walton RD, Robinson S, Brookes-Fazakerly S, Chang FY, McGonagle L, Wright D. Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures: a comparative study from a tertiary centre. J Pediatr Orthop B. 2016 Jan 1;25(1):69-73.
39. De SD, Bae DS, Waters PM. Displaced humeral lateral condyle fractures in children: should we bury the pins? J Pediatr Orthop. 2012 Sep 1;32(6):573-8.
40. Thomas DP, Howard AW, Cole WG, Hedden DM. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop 2001: 21(5):565–569
41. Andrey V, Tercier S, Vauclair F, Bregou-Bourgeois A, Lutz N, Zambelli PY. Lateral condyle fracture of the humerus in children treated with bioabsorbable materials. Sci World J 2013: 9:869418.

How to Cite this Article:  Basa V, Shah A, Parikh SN | Complications of Lateral Humeral Condyle Fractures in Children | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 42-47.

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Editorial

Volume 7 | Issue 2 | May-August 2021 | Page: 01 | Jayant  S. Sampat

Authors: Jayant S. Sampath FRCSEd (Tr&Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Warm greetings to all from the International Journal of Paediatric Orthopaedics Editorial Team.

We are pleased to present the 3rd POSI issue of IJPO. Thanks to the overwhelming response to our invitation for submissions, our team of reviewers and editors have been kept busy in the past few months. We would like to express our gratitude to the entire POSI family from around the world and to all the authors for their submissions. With your continued support, the journal will reach great heights in the years to come.
This issue has an informative and exhaustively researched symposium on lateral condyle fractures of the humerus. The articles in the symposium will provide a comprehensive and updated overview about this condition that poses significant challenges to the treating surgeon. The authors are acknowledged experts in paediatric trauma from India and around the world. It has been specially designed to supplement the material available in orthopaedic textbooks for the benefit of trainees, in addition to providing treatment pearls for the practising orthopaedic surgeon.
We have original articles and interesting case reports from India, United Kingdom, Portugal, Senegal on a wide variety of paediatric orthopaedic conditions including DDH, infection and its sequelae and clubfoot managed in diverse healthcare systems.
Due to the unprecedented increase in submissions, we call upon the POSI fraternity to help the society journal by joining our team of reviewers. This will help us to complete the peer review process in a timely manner. Being a part of our team will help also young surgeons to better understand the review process and develop their writing skills.
We look forward to hearing from you with suggestions for further improvement.

Sincerely

Jayanth S Sampath FRCSEd (Tr & Orth)
Editor, International Journal of Paediatric Orthopaedics
editor.ijpo@gmail.com

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 01.

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Surgical Treatment of Pathological Developmental Dysplasia of the Hip: A 12-Year Study

Volume 7 | Issue 2 | May-August 2021 | Page: 02-06 | Qaisar Choudry, Robin W. Paton

Authors: Qaisar Choudry [1], Robin W. Paton [1]

[1] Department of Orthopaedics, East Lancashire Hospitals NHS Trust, England.

Address of Correspondence
Dr. Qaisar Choudry
Department of Orthopaedics, East Lancashire Hospitals NHS Trust, England.
E-mail: qaisar.choudry@elht.nhs.uk

Abstract

Aim: We aimed to assess outcomes of a 12-year longitudinal observational study of developmental dysplasia of the hip (DDH) requiring surgical intervention.

Method: We conducted a prospective study from 2004 to 2015 of all cases of DDH undergoing surgical intervention. In addition to clinical examination, Tönnis acetabular index (AI) method and International Hip Dysplasia Institute (IHDI) grading used.  Avascular necrosis of the femoral head (AVN) was assessed by the Kalamchi method.

Results & Discussion: There were 81 hips in 72 patients (12 male, 60 female).  Mean age of the first operative procedure was 16.4 months (95% CI, 13.66 to 19.14). Mean follow up was 47.6 months (95% CI, 41.8 to 53.4). 31 children underwent closed reductions, 48 required open reduction; 17 femoral and 39 pelvic osteotomies were performed during the course of the study. Overall, post-surgery 96.3 % were noted to have an acceptable AI (< 2 SD of the mean).  Five hips were considered to have poor results due to residual subluxation/ dislocation (6.2%).  Evidence of avascular necrosis was present in 16 of the 81 hips (19.8%).

Higher grades of hip pathology were generally associated with a later age of diagnosis and likely to require more extensive surgical interventions.

Conclusion: Operative intervention for DDH results in acceptable clinical and radiographic outcomes in the vast majority of children.

Keywords: DDH, Developmental Dysplasia of the hip, Surgery.

References 

  1. Klisic P.J. Congenital dislocation of the hip – a misleading term. J Bone Joint Surg. Br. 71-B (1): 136, 1989.
  2. Gardiner HM, Dunn PM. Controlled trial of immediate splinting versus ultrasonography surveillance in congenitally dislocatable hips. Lancet 336(8730): 1553–6, 1990.
  3. Paton R. Does selective ultrasound imaging of ‘at risk’ hips and clinically unstable hips, in Developmental Dysplasia of the Hip (DDH) produce an effective screening programme? University of Lancaster; uk.bl.ethos.618206, 2011.
  4. Kotlarsky P. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop. 6(11): 886, 2015.
  5. Khoshhal KI, Al Khelaifi AS. Predictive radiographic factors in DDH management. J Taibah Univ Med Sci. 6(1):19–25, 2011.
  6. Morin C, Wicart P. Congenital dislocation of the hip, with late diagnosis after 1 year of age: Update and management. Orthop Traumatol Surg Res. 98(SUPPL. 6): 154–8, 2012.
  7. Düppe H, Danielsson LG. Screening of neonatal instability and of developmental dislocation of the hip. A survey of 132,601 living newborn infants between 1956 and 1999. J Bone Joint Surg Br. 84(6):878–85, 2002.
  8. von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, et al. Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet. Dec 6; 362(9399):1883–7, 2003.
  9. Myers J, Hadlow S, Lynskey T. The effectiveness of a programme for neonatal hip screening over a period of 40 years: a follow-up of the New Plymouth experience. J Bone Joint Surg Br. Feb; 91(2):245–8, 2009.
  10. Judd J, Clarke NMP. Treatment and prevention of hip dysplasia in infants and young children. Early Hum Dev. Nov; 90(11):731–4, 2014.
  11. Jones D, Dezateux CA, Danielsson LG, Paton RW, Clegg J. At the crossroads–neonatal detection of developmental dysplasia of the hip. J Bone Joint Surg Br. 82(2):160–4, 2000.
  12. Herring JA. Conservative treatment of congenital dislocation of the hip in the newborn and infant. Clin Orthop Relat Res. 1992 Aug; (281):41–7, 1992.
  13. Suzuki S, Kashiwagi N, Kasahara Y, Seto Y, Futami T. Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound. J Bone Joint Surg Br. 78(4):631–5, 1996.
  14. Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics. Jan; 103(1):93–9, 1999.
  15. Lancashire County Council. Births, deaths and fertility rates [Internet] Available from: https://www.lancashire.gov.uk/lancashire-insight/population-and-households/population/births-and-deaths/[Accessed 17/04/19].
  16. Narayanan U, Mulpuri K, Sankar WN, Clarke NMP, Hosalkar H, Price CT, et al. Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip. J Pediatr Orthop. 35(5):478–84, 2015.
  17. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. Sep ;( 119): 39–47, 1976.
  18. Kalamchi A, MacEwen GD: Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg 62A:876–888, 1980.
  19. BSCOS. DDH guidelines on closed and open reduction, members/ revalidation section, bscos.org.uk [Accessed 17/04/19].
  20. Public Health England. Newborn and infant physical examination screening programme handbook – GOV.UK Available from: https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook [Accessed 18/04/19].
  21. Robinson R. Effective screening in child health. BMJ, 316(7124): 1–2, 2011.
  22. Sanghrajka AP, Murnaghan CF et al, Open reduction of developmental dysplasia of the hip: the failures of screening or failures of treatment. Ann R Coll Surg Eng 95(2): 113-117, 201.
  23. Choudry Q, Paton RW. Pavlik harness treatment for pathological developmental dysplasia of the hip: meeting the standard? J Pediatr Orthop B. Jul; 26(4):293–7, 2017.
  24. Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop. 21(3): 348–53, 2001.
  25. Ömeroğlu H, Köse N, Akceylan A. Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip. Clin Orthop Relat Res. May 6; 474(5): 1146–52, 2016..
  26. Bin K, Laville J-M, Salmeron F. Developmental dysplasia of the hip in neonates: evolution of acetabular dysplasia after hip stabilization by brief Pavlik harness treatment. Orthop Traumatol Surg Res. Jun; 100(4):357–61, 2014.
  27. Wynne-Davies R. Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families. J Bone Joint Surg Br Nov; 52(4):704–16, 1970.
  28. Glorion C, Surgical reduction of congenital hip dislocation, Orthopaedics & Traumatology, Surgery & Research, 104, 5147-57, 2018.
  29. Pospiscill R et al, Does open reduction of Developmental Dislocated Hip increase the risk of osteonecrosis? Clinical Orthopaedics & Related Research, 470(1): 250-260, 2012.
How to Cite this Article:  Choudry Q, Paton RW | Surgical Treatment  of Pathological Developmental Dysplasia of the Hip: A 12-Year Study | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 02-06.

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Management of Acute Lateral Condyle Fractures of Humerus

Volume 7 | Issue 2 | May-August 2021 | Page: 30-34 | Sandeep Patwardhan, Arkesh Madegowda

Authors: Sandeep Patwardhan [1], Arkesh Madegowda [1]

[1] Department of Paediatric Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune Maharashtra, India.

Address of Correspondence
Dr Sandeep Patwardhan,
Professor, Paediatric Orthopaedic surgeon, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: sandappa@gmail.com

Abstract

Lateral condyle fractures of humerus are one of the common elbow injuries seen in children. These fractures are often difficult to visualise as fracture line passes through unossified cartilage and may need additional investigations to properly assess the fracture pattern. Non operative management is generally indicated for fractures having <2mm displacement. Closed reduction and percutaneous pinning is recommended for those fractures with >2mm displacement and loss of articular cartilage hinge. Intraoperative arthrogram helps to confirm the fracture reduction and restoration of congruent articular surface. Open reduction and fixation may become necessary for fractures with gross displacement and malrotation of the fragment. Complications of lateral condyle fractures include delayed presentation, malunion, lateral spurring and fishtail deformity.
Keywords: Lateral condyle fractures, Internal oblique view, Arthrogram, Aartilage hinge, Displacement.

References

1. Bhandari M, Tornetta P and Swiontkowksi MF The Evidence-Based Orthopaedic Trauma Working Group. Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma 2003; 17: 306–308.
2.Hardacre JA, Nahigian SH, Froimson AI and Brown JE.Fractures of the lateral condyle of the humerus in children. J Bone Joint Surg Am 1971; 53: 1083–1095.
3.Song KS, Kang CH, Min BW, Bae KC, Cho CH. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am. 2007 Jan;89(1):58-63.
4. Horn BD, Herman MJ, Crisci K, Pizzutillo PD, MacEwen GD. Fractures of the lateral humeral condyle: role of the cartilage hinge in fracture stability. J Pediatr Orthop. 2002 Jan-Feb;22(1):8-11
5. Kamegaya M, Shinohara Y, Kurokawa M, Ogata S. Assessment of stability in children’s minimally displaced lateral humeral condyle fracture by magnetic resonance imaging. J Pediatr Orthop. 1999 Sep-Oct;19(5):570-2.
6. Song KS, Kang CH, Min BW, Bae KC, Cho CH, Lee JH: Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. J Bone Joint Surg Am 2008;90:2673-2681.
7.Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL: A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 2009;29:602-605.
8. Qin YF, Li ZJ, Li CK, Bai SC, Li H. Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures: A meta-analysis. Medicine (Baltimore). 2017 Aug;96(34):e7736.
9. McGonagle L, Elamin S, Wright DM. Buried or unburied K-wires for lateral condyle elbow fractures. Ann R Coll Surg Engl. 2012 Oct;94(7):513-6.
10. Xie LW, Wang J, Deng ZQ, Zhao RH, Chen W, Kang C, Ye JJ, Liu X, Zhou Y, Shen H. Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord. 2020 Oct 27;21(1):707.
11. Abzug JM, Dua K, Kozin SH, Herman MJ. Current Concepts in the Treatment of Lateral Condyle Fractures in Children. J Am Acad Orthop Surg. 2020 Jan 1;28(1):e9-e19.
12. Tomori Y, Nanno M, Takai S. Anterolateral approach for lateral humeral condylar fractures in children: Clinical results. Medicine (Baltimore). 2018 Sep;97(39):e12563.
13. Skak SV, Olsen SD, Smaabrekke A:Deformity after fracture of the lateral humeral condyle in children. J Pediatr Orthop B 2001;10:142-152.
14. Park H, Hwang JH, Kwon YU, Kim HW: Osteosynthesis in situ for lateral condyle nonunion in children. J Pediatr Orthop 2015;35:334-340.
15. Liu TJ,Wang EB, DaiQ, Zhang LJ, Li QW, Zhao Q: Open reduction and internal fixation for the treatment of fractures of the lateral humeral condyle with an early delayed presentation in children: A radiological and clinical prospective study. Bone Joint J 2016;98-B:244-248.
16. Agarwal A, Qureshi NA, Gupta N, Verma I, Pandey DK: Management of neglected lateral condyle fractures of humerus in children: A retrospective study. Indian J Orthop 2012;46:698-704.
17. Narayanan S, Shailam R, Grottkau BE, Nimkin K: Fishtail deformity: A delayed complication of distal humeral fractures in children. Pediatr Radiol 2015;45:814-819.
18. Cates RA, Mehlman CT: Growth arrest of the capitellar physis after displaced lateral condyle fractures in children. J Pediatr Orthop 2012;32:e57-e62.

How to Cite this Article:  Patwardhan S, Madegowda A | Management of Acute Lateral Condyle Fractures of Humerus | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 30-34.

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