This study assessed the current concepts of pediatric elbow fractures. PubMed and Embase databases were searched for publications in English on elbow fractures. Papers believed to yield significant findings to this area were included in this review. The supracondyle of humerus, lateral condyle of the humerus, proximal radius, and proximal ulna fractures were included. Sixteen papers and textbooks were selected. Pediatric elbow fractures should be evaluated for combined injuries. Treatment should be done accurately for each fracture for the further growth of children.
PURPOSE The current study is planned to evaluate varus stress test and a result of percutaneous K-wire fixation in the minimally displaced lateral condyle fracture of humerus in children. MATERIALS AND METHODS We have analyzed seven patients of Jakob stage I or II lateral condylar fracture of the humerus clinically and radiologically who were managed with closed reduction and percutaneous K-wire fixation from July 1996 to June 1999. Their ages at the time of injury ranged 2.5 to 11.7 years (average 6.3 years). We checked varus stress view for evaluating fracture stability and treatment plan. RESULTS The patients were followed up for average 13 months postoperatively and showed no differences in carrying angle, range of motion and physical activity compared with contralateral elbow. K-wires were removed average 6 weeks postoperatively. The fractures were united at average 5.9 weeks (5-9 weeks). There were minor complications ; one case of bony overgrowth, three cases of bony spur and one case of pin site infection. The treatment results according to Hardacre's assessment were excellent in all cases. CONCLUSION Varus stress view is necessary to evaluate the fracture stability and to make treatment plan in minimally displaced lateral condyle fracture, and closed reduction followed by percutaneous K-wire fixation can be used successfully in the cases of unstable Jakob stage I and reducible Jakob stage II.
PURPOSE : We tried to define the complications related to the degree of injury and the treatment modalities in surgically treated lateral condylar fracture of the humerus in children.
MATERIAL : We experienced 42 children under 15 years of age who were diagnosed lateral humeral condylar fracture and treated by operation. The follow up periods were from 6 months to 39 months, average 15.2 months. There were 4 cases of Milch type I fracture and 38 cases of Milch type II fractures. According to the displacement, there were 9 cases of stage I fracture, 20 cases of stage II fracture, and 13 cases of stage III fracture. The age distribution was from 1.5yrs. to 13yrs.(average ; 5.2years) and there were 26 male children and 16 female children. METHOD : 6 cases of stage I fracture and 2 cases of stage II fracture were treated by maunal reduction and percutaneous K-wire fixation. 3 cases of stage I fracture revealed incongruency of articular surface, 18 cases of stage II fractures and 13 cases of all stage III fracture were treated by open reduction and percutaneous K-wire fixation. RESULT : There 13 cases of lateral bony hypertrophic(30.9%), 4 cases of minimal limitation of elbow joint motion(9.5%), 3 cases of hypertrophic skin scar(7.1%), 2cases of pin tract infection(4.8%), one case of slight decrease of carrying angle(2.4%). Howerer there was no serious complication such as nonunio or cubitus valgus. Limitation of elbow joint motion occurred significantly higher in Milch type I fracture(2 cases, 50%) than Milch type II fracture(2 cases, 5.3%)(p<0.05). Lateral bony hypertroph occurred significantly higher in open reduction(12cases, 35.3%) than in manual reduction(one case, 12.5%)(p<0.05). Also lateral bony hypertrophy occurred higher in moderate and severe displaced fractures(stage II and III ; 12cases, 36.4%) than in minimal displaced fractures(stage I ; one cases, 11.1%)(p<0.05). CONCLUSION : In the displaced lateral humeral condylar fractures in children, the serious complications can be avoided through selecting adequate treatment modality. In the case of open reduction, the possibility, the possibility of lateral bony hypertrophy should be minded.
PURPOSE : To emphasize the importance of the oblique view of elbow in diagnosis of the lateral condylar fracture traversing the capitulum to propose an appropriate treatment reducing the complication. MATERIALS AND METHODS : We analyzed eight cases of lateral condylar fracture traversing the capitulum among the 192 cases of lateral condylar fracture with preoperative complete roentgenogram and medical record from April, 1992 to September, 1998. RESULTS : In seven cases, it was possible to diagnose as lateral condylar fracture of humerus in initial anteroposterior and lateral view, but it had a difficulty to decide whether fracture line traversing the capitulum. The oblique view provided accurate fracture line to diagnose. One case was diagnosed fracture line traversing the capitulum in lateral view. There was no considerable complications at 18 months follow up in average, except one case with malunion that was transferred form other hospital after operation. CONCLUSION : To make a diagnosis of the lateral condylar fracture traversing capitulum, the oblique view is helpful. We considered that internal fixation is require because the fragment can be displaced progressively.
Fracture of the lateral condyle of humerus in children are common injury next to supracondylar fracture in children, account for 10 to 15% about the elbow and 18 to 20% about distal humerus fractures. This is the one fracture that can be overlooked clinically and that has a high potential for nonunion and cubitus valglls deformity.
Sixty children treated by closed or open reduction with internal fixation on the lateral condyle fracture of humerus from January 1994 to August 1997, were reviewed. Almost fractures were treated within 12 hours after injury for the purpose of prevention of further displacement and occurrence of complication.
According to Hardacre et als criteria, most patients showed excellent and good results. We report the result after surgical treatment on the laterdl condyle fracture of humerus in children.
The authors analysed the 40 patients of the lateral condyle fracture of the humerus in children who were admitted in Korea Veterans Hospital in Seoul from Jan. 1990 to Dec. 1997. The fracture type and the displacement was classified according to Milch type and Jakob stage. Clinical analysis was performed on 40 patients with lateral condyle fracture of humerus, who could be followed up. The patients were followed up from 12 months to 63 months with an average of 23 months. Average duration of bone union was 6 weeks after operation. The significant differences in outcome were notified from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. According to the criteria of Hardacre, we obtained excellent result in 16 cases(40%), good result in 22 cases(55%) and poor results in 2 cases(5%).
Fracture of the lateral humeral condyle is a relatively common injury in children. It is an itraarticular fracture involving the growth plate so, the treatment should be done very carefully to reduce aditional damage and complication. The authors analyzed 34 fractures of the lateral humeral condyle in children who were treated from Mar. 1993 to Feb. 1998, to know the releationship between the factors affecting the development of complications and the results. The results were summerized as follows ; 1. There were 1 case (2.9 %) of Milch type I and 33 cases (97.1 %) of Milch ype II, and according to Jakob' stage, 9 case (26.5 %) of stage I, 19 cases (55.9 %) of stage II, and 6 cases (17.6 %) of stage III. 2. They were treated with cast immobilization in 5 cases (14.7 %), with closed rduction and percutaneous K-wire pinning in 8 cases (23.5%), and with open reduction and K-wire fixation in 21 cases (61.8%). 3. According to the criteria of Hardacre, the result of 5 cases of cast immobilization were excellent, 8 cases of closed reduction and percutaneous K-wire pinning were 3 excellent, 4 good, 1 poor, and 22 cases of open reduction and K-wire fixation were 19 excellent, 2 good, so there were 22 cases (64.7%) excellent, 11 cases (32.4%) good, and 1 case (2.9%)poor. 4. The complications were 11 cases (32.4%) of bony spur, 6 cases (17.6%) of overgrowth of the lateral condylar or capitellum, 1 case (2.9%) of premature epiphyseal fusion, and 2 cases (5.9%) of pinning site infection.
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Synthesis and Characterization of Large NaX Zeolite Crystals by Continuous Crystallization Hae Jin Lee, Hyung Mi Lim, Ik Jin Kim Materials Science Forum.2005; 492-493: 731. CrossRef
Authors experienced a rare injury in a 5-year-old girl with Monteggia fracture and concomitant lateral condyle fracture of humerus with radial nerve injury. This combined injury has not been reported in the literature. This unusual fractures were treated by open reduction and K-wire fixation of lateral condyle fracture and transcapitellar K-wire fixation of radial head dislocation. An excellent result was obtained with operative treatment.
Treatment of lateral condyle fracture has been traditionally divided to closed and open treatment. Minimal displaced fracture of lateral humeral condyle can be appropriately treated with closed reduction and percutaneous K-wire fixation. Adherence to these guidelines is likely to prevent malunion, nonunion, premature epiphyseal closure, ulnar neue palsy, and cubitus valgus deformity, all possible complications of this fracture.
Since September 1993, we managed 20 children with lateral condyle fracture of elbow using closed reduction and percutaneous pinning. And intraoperative arthrogram was done to confirm the reduction status. Pins were removed 6 weeks postoperatively. The average period of follow-up was 24 months. There was no significant difference in carrying angle, range of motion and physical activity compared to contralateral elbow. Valgus - varus stress view is a useful method in evaluating fracture stability and rupture of cartilage hinges and valgus - supination stress view is very useful for confirming the reduction. Arthrogram was considered to be useful in evaluating the reduction state and deciding the treatment plan.
Tibial condyle fracture involving articular surface can produce some disabilities of the knee because they are usually accompanied with the injuries of the ligaments and menisci. Though recent studies suggest that anatomical reduction and rigid fixation of the fracture followed by early knee mobilization have improved clinical end results, the results were not always successful. The lateral condyle fracture is more often in the incidence than the medial one. This is due to the physiologic valgus of the knee, the weaker trabeculation under the lateral tibial plateau, and the increased frequency of valses injuries as the knee is protected medially by the contralateral side.
Eighteen lateral condyle fractures of the tibia treated by open reduction and internal fixation at the Our Lady of Mercy Hospital from June 1991 through February 1995 were analized.
The results are as follows.
1. The patients were 13 males and 5 females, mean age was 39.2 years and mean follow up-period was 19.2 months.
2. The most common cause was motor vehicle accident(8 cases,44.4%).
3. The most frequent type of fracture was split(8 cases,44.4%) by Rasmussens lateral condyle fracture classification and the next was split-compression(6 cases,33.3%).
4. According to Blokkers criteria,15 cases(83.3%) had satisfactory results.
Among 3 cases of unsatisfactory results, 1 developed secondary degenerative change, 1 had valgus instability and 1 secondary degenerative change and mild valgus instability.
It is thought that the most important factor influencing results was the anatomical reduction of the articular surface, rigid fixation and early joint mobilization.
Fractures of the lateral condyle of the humerus are notorious for complications, most commonly nonunion with subsequent proximal migration of the ununited fragment, an increase in the carrying angle, and the tardy ulnar nerve palsy. In the past, the reconstructive surgery for complicated old fractures of the lateral condyle of the humerus had been hardly considered, but recently, attempts have been made to reconstruct the anatomy and function of the elbow joint.
The authors have reviewed 21 cases of old fractures of the lateral condyle of the humerus, which had been treated at Seoul National University Hospital from April,1982 until March, 1990.
For established nonunions of the lateral condyle fragment, better results were obtained from the procedure that includes osteosynthesis of the lateral condyle, attempting to restore the normal anatomy of the elbow joint. For tardy ulnar nerve palsies, better results were obtained from the procedure that includes medial epicondylectorny.
Fractures of the lateral humeral condyle have many late problems in spite of treatment at the time of injury so early aggressive treatment is necessary. Even in cases with late problems, aggressive treatment should be done, too, as soon as possible.
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In SituLate Metaphyseal Osteosynthesis for the Fractures of the Lateral Humeral Condyle in Children Kun Bo Park, Seung Whan Lee, Hyun Woo Kim, Hui Wan Park, Ki Seok Lee Journal of the Korean Fracture Society.2008; 21(2): 151. CrossRef