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

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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.
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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
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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.
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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.
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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

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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.
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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.
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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.

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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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