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Topic:

Lateral Humeral Condyle Fracture

Issue:

Elbow

Category:

Trauma

Title:

Management of Lateral Condyle Humeral Fracture Associated With Elbow Dislocation in Children: A Retrospective International Multicenter Cohort Study

Author:

Masquijo, Julio Javier MD; Sanchez Ortiz, Milca MD; Ponzone, Agustina MD; Fernández Korosec, Lucas MD; Arkader, Alexandre MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p 82-88, DOI: 10.1097/BPO.0000000000002574

Level Of Evidence:

III

# of Patients:

23

Study Type:

Retrospective multicenter cohort study

Location:

Multiple international institutions

Summary:

This study focuses on the management of lateral condyle humeral fractures associated with elbow dislocation (ED) in children. It aims to identify the best treatment strategies, risk factors for complications, and predictors of outcomes for this rare injury combination.

Methods:

Retrospective review of medical records for skeletally immature patients diagnosed with lateral condyle humeral fractures associated with elbow dislocation. Data collected included patient demographics, fracture classification, dislocation direction, treatment methods, union time, elbow range of motion, complications, and additional procedures. Outcomes were assessed using the modified Flynn criteria.

Exclusions:

Not specified

Results:

Demographics: Mean age of 8.7 years, with 79% male patients. Treatment: Open reduction with a modified Kocher lateral approach, using either Kirschner wires (12 cases) or cannulated screws (9 cases). Complications: 34.8% developed complications, including elbow stiffness (5 cases), instability (1 case), and avascular necrosis (2 cases). Fixation methods: Patients treated with casting or Kirschner wire fixation had a significantly higher rate of elbow stiffness compared to screw fixation (50%, 25%, and 11%, respectively; P = 0.015). Outcomes: 65% of patients had good or excellent outcomes, while 35% had poor outcomes according to Flynn’s criteria.

Conclusions:

A higher-than-expected rate of complications was observed in children with lateral condyle humeral fractures associated with ED, including persistent elbow stiffness, avascular necrosis, and instability. Internal fixation with screws and a shorter postoperative immobilization period (2 weeks) may improve clinical outcomes.

Relevance:

Limitations:

Perspective:

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