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Lateral condylar fractures of the humerus in children.

Abstract Aims Displaced fractures of the lateral condyle of the humerus are frequently managed surgically with the aim of avoiding nonunion, malunion, disturbances of growth and later arthritis. The ideal method of fixation is however not known, and treatment varies between surgeons and hospitals. The aim of this study was to compare the outcome of two well-established forms of surgical treatment, Kirschner wire (K-wire) and screw fixation. Patients and Methods A retrospective cohort study of children who underwent surgical treatment for a fracture of the lateral condyle of the humerus between January 2005 and December 2014 at two centres was undertaken. Pre, intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean age at the time of injury was 5.8 years (0 to 15) with a male:female patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture and the fracture was displaced by > 2 mm in 228 (68%). In all, 235 patients underwent K-wire fixation and 101 had screw fixation. Results There was a higher rate of nonunion with K-wire fixation (p = 0.02). There was no difference in Baumann's angle, carrying angle or the rate of major complications between the two groups. No benefit was obtained by immobilizing the elbow for more than four weeks in either group. No short-term complications were seen when fixation crossed the lateral ossific nucleus. Conclusions Fixation of lateral condylar humeral fractures in children using either K-wires or screws gives satisfactory results. Proponents of both techniques may find justification of their methods in our data, but prospective, randomized trials with long-term follow-up are required to confirm the findings, which suggest a higher rate of nonunion with K-wire fixation. Cite this article: Bone Joint J 2018;100-B:387-95.
PMID
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Authors

Mayor MeshTerms
Keywords

Fixation

Humerus

Lateral condylar fracture

Malunion

Nonunion

Paediatrics

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589493
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - Lateral condylar fractures of the humerus in children.
PG  - 387-395
LID - 10.1302/0301-620X.100B3.BJJ-2017-0814.R1 [doi]
AB  - Aims Displaced fractures of the lateral condyle of the humerus are frequently
      managed surgically with the aim of avoiding nonunion, malunion, disturbances of
      growth and later arthritis. The ideal method of fixation is however not known,
      and treatment varies between surgeons and hospitals. The aim of this study was to
      compare the outcome of two well-established forms of surgical treatment,
      Kirschner wire (K-wire) and screw fixation. Patients and Methods A retrospective 
      cohort study of children who underwent surgical treatment for a fracture of the
      lateral condyle of the humerus between January 2005 and December 2014 at two
      centres was undertaken. Pre, intraoperative and postoperative characteristics
      were evaluated. A total of 336 children were included in the study. Their mean
      age at the time of injury was 5.8 years (0 to 15) with a male:female patient
      ratio of 3:2. A total of 243 (72%) had a Milch II fracture and the fracture was
      displaced by > 2 mm in 228 (68%). In all, 235 patients underwent K-wire fixation 
      and 101 had screw fixation. Results There was a higher rate of nonunion with
      K-wire fixation (p = 0.02). There was no difference in Baumann's angle, carrying 
      angle or the rate of major complications between the two groups. No benefit was
      obtained by immobilizing the elbow for more than four weeks in either group. No
      short-term complications were seen when fixation crossed the lateral ossific
      nucleus. Conclusions Fixation of lateral condylar humeral fractures in children
      using either K-wires or screws gives satisfactory results. Proponents of both
      techniques may find justification of their methods in our data, but prospective, 
      randomized trials with long-term follow-up are required to confirm the findings, 
      which suggest a higher rate of nonunion with K-wire fixation. Cite this article: 
      Bone Joint J 2018;100-B:387-95.
FAU - Ganeshalingam, R
AU  - Ganeshalingam R
AD  - The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia.
FAU - Donnan, A
AU  - Donnan A
AD  - The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia.
FAU - Evans, O
AU  - Evans O
AD  - Sheffield Children's Hospital, Western Bank, Sheffield, UK.
FAU - Hoq, M
AU  - Hoq M
AD  - Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research
      Institute, Royal Children's Hospital, 50 Flemington Road, Parkville Victoria
      3052, Australia.
FAU - Camp, M
AU  - Camp M
AD  - The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G1X8, 
      Canada.
FAU - Donnan, L
AU  - Donnan L
AD  - The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Bone Screws
MH  - Bone Wires
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Fracture Fixation, Internal/instrumentation/*methods
MH  - Humans
MH  - Humeral Fractures/*surgery
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Fixation
OT  - Humerus
OT  - Lateral condylar fracture
OT  - Malunion
OT  - Nonunion
OT  - Paediatrics
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0814.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):387-395. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0814.R1.