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.

 

.


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.

(Article Text HTML)      (Download PDF)