Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children

Authors

  • Rajendra Sanjel Chhetri Department of Orthopedics, Lumbini Zonal Hospital, Butwal, Nepal, Department of Orthopedics, Lumbini Hospital and technical college, Butwal, Nepal
  • Indra Dhakal Department of Orthopedics, Lumbini Zonal Hospital, Butwal, Nepal
  • Gopal Gnawali Department of Orthopedics, Lumbini Zonal Hospital, Butwal, Nepal

DOI:

https://doi.org/10.31729/jnma.3337

Keywords:

lateral condyle fracture; late presentation; operative management.

Abstract

Introduction: Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children.

Methods: We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria.

Results: We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united.

Conclusions: Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.

References

1. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br.1975 Nov;57(4):430-6. [PubMed | Full Text]
2. Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988 Aug;59(4):419-24. [PubMed]
3. Shabir A, Tahir A, Sharief A, Imtiyaz H, Shahid H, Reyaz A. Delayed operative management of fractures of the lateral condyle of the humerus in children. Malays Orthop J. 2015;9(1):18-22. [PMC | Full Text]
4. 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. [PMC | Full Text]
5. Eamsobhana P, Kaewpornsawan K. Should we repair nonunion of the lateral humeral condyle in children?. Internat Orthop. 2015;39:1579-85. [Full Text]
6. Kimball JP, Glowczewskie F, Wright TW. Intraosseous blood supply to the distal humerus. J Hand Surg. 2007;32(5):642–6. [Full Text]
7. Gaur SC, Varma AN, Swarup A. A new surgical technique for old ununited lateral condyle fractures of the humerus in children. J Trauma. 1993 Jan;34(1):68-9.[PubMed | Full Text]]
8. Sulaiman AR, Munajat I, Mohd EF. A modified surgical technique for neglected fracture of lateral humeral condyle in children. J Pediatr Orthop B. 2011 Nov;20(6):366-71. [PubMed]
9. Kurtulmus T, Saglam N, Saka G, Avci CC, Ugurlar M, Turker M. Paediatric lateral humeral condyle fractures: internal oblique radiographs alter the course of conservative treatment. Eur J Orthop Surg Traumatol. 2014;24(7):1130-44. [Full Text]
10. 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. [PubMed | Full Text]
11. Saraf SK, Khare GN. Late presentation of fractures of the lateral condyle of the humerus in children. Indian J Orthop. 2011;45(1):39-44. [PMC | DOI]
12. Longo UG, Franceschi F, Loppini M, Maffulli N, Denaro V. Rating systems for evaluation of the elbow. Br Med Bull. 2008;87:131–161. [PubMed | Full Text]
13. Canale ST, Beaty JH. Fractures and dislocations in children. In: Canale ST, Beaty JH (eds.) Campbell’s Operative Orthopaedics.12th ed.Vol 2. Philadelphia; Elsevier Mosby: 2013. p.1394-8. [Full Text]
14. Pribaz JR, Bernthal NM, Wong TC, Silva M. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop. 2012 Jul-Aug;32(5):456-60. [PubMed | DOI]
15. Frongia G, Janosi C, Mehrabi A, Schenk JP, Günthe P. Long-term outcome in displaced lateral humeral condyle fractures following internal screw fixation in children. Acta Orthop. Belg. 2016;82:889-95. [Full Text]
16. 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;37(1):7-13. [Full Text | DOI]
17. Hasler CC, Von Laer L. Prevention of growth disturbances after fractures of the lateral humeral condyle in children. J Pediatr Orthop B. 2001 Apr;10(2):123-30. [PubMed]

Downloads

Published

2018-02-28

How to Cite

Sanjel Chhetri, R., Dhakal, I., & Gnawali, G. (2018). Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children. Journal of Nepal Medical Association, 56(209), 527–530. https://doi.org/10.31729/jnma.3337

Issue

Vol. 56 No. 209 (2018)

Section

Original Article

License

JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a Creative Commons Attribution 4.0 International License. More about Copyright Policy.