Fracturas del cndilo lateral hmeral

en nios

Hospital Jurez de Mxico

Lina Martnez R3 TyO

 Las fracturas del cndilo lateral del

hmero son las segundas ms
frecuentes en los nios y constituyen
54% de todas las lesiones fisarias.
Se describen dos mecanismos de
produccin: por arrancamiento y por
empuje.

 Tipo I. El trazo atraviesa el ncleo

de osificacin del cndilo lateral.
Tipo II. La fractura recorre hasta el
centro de la escotadura de la trclea.

OUTCOME OF LATERAL HUMERAL CONDYLAR MASS FRACTURES

IN CHILDREN ASSOCIATED WITH ELBOW DISLOCATION OR
OLECRANON FRACTURE TREATED WITH ORIF WITH KIRSCHNER
NEEDLES

International Orthopaedics (SICOT) (2009) 33:509514

H. Sharma & M. Sibinski & D. A. Sherlock

t Of 2,502 elbow/humeral injuries treated at our department

between 1990 and 2005, we identified a cohort of 20 lateral
condylar mass (LCM) fractures of the humerus in children
associated with elbow dislocation (n=12; mean age 8.2
years) or with olecranon fracture (n=8; mean age 4.1 years).
Eight patients with undisplaced fracture pattern were
treated conservatively yielding a satisfactory outcome.
Good to excellent results were obtained in the majority
(85%). Overall, the result was poor in three patients (15%;
25% of the operated cohort) due to terminal 2030 loss of
extension.
There was no obvious difference in the outcome between
the isolated displaced LCM fractures described in the
literature and this cohort. Testing of elbow stability by
examination under anaesthesia is stressed. Undisplaced
fracture patterns need to be closely observed.

The posterolateral approach to the distal humerus for

open reduction and internal fixation of fractures of the
lateral condyle in children

N. Mohan, J. B. Hunter, C. L. Colton

From the University Hospital,
Nottingham, England
5, jul 2010

 We reviewed 20 children with displaced fractures

of the lateral condyle treated between 1993 and
1996 (Fig. 1). Their mean age was seven years .
All the patients were operated on within 24 hours
of injury and an accurate reduction was achieved.
The fractures were fixed with a cancellous screw
though the metaphyseal fragment.
A Kirschner wire was used to augment the fixation
when the metaphyseal fragment was small.
Immobilisation was used for a period of four to six
weeks, and the final outcome assessed at a mean
of 12 months (6 to 24) after the operation.

Results
The mean follow-up was for 12 months.
There were no intraoperative or postoperative
complications.
All the fractures healed satisfactorily and were united
at the time of radiological assessment at three
months.
There were no angular deformities at review. There
were no cases of avascular necrosis, nonunion or
epiphyseal overgrowth.
The skin wounds healed well and the cosmetic
appearance was acceptable. In all patients there was
a full range of movement.

Pediatric Lateral Condyle Humeral Fractures With and

Without Associated Elbow Dislocations: A
Retrospective Study

Kevin Lemme, MD, John P. Lubicky, MD, Amer Zeni,

MD, and Elizabeth Riley, MIS, MLS
Am J Orthop. 2009;38(9):453-456. Copyright,
Quadrant HealthCom Inc. 2009. All rights reserved.

 We conducted a retrospective chart and

radiographic review of 906 pediatric elbow
fracture patients who had been admitted
to or evaluated at Riley Hospital for
Children and Wishard Memorial Hospital in
Indianapolis, Indiana, between 1990 and
2006.
We identified 118 consecutive patients
with lateral condyle fractures with or
without ipsilateral elbow dislocations

Conlcussion
Treatment of minimally displaced
lateral condyle fractures is somewhat
controversial.
However, as the elbow structures in
this age group are incompletely
ossified, determining the amount of
displacement can be difficult, and
the amount can be misleading.

 Treatment decisions were usually

based on amount of fracture
displacement at initial presentation.
Most undisplaced fractures and
minimally displaced (-2mm)
fracturwa were treated
nonoperatively closed with cast
unless followup showed a displaced
fracture.

 Thirty-five patients (30%) underwent only closed

treatment, with a cast; the other 83 patients (70%)
underwent surgical treatment (type depended on
whether reduction was closed or open).
However, all patients underwent fracture stabilization
with some form of fixation. In 4 patients, closed reduction
was unsuccessful and was converted to open reduction
to achieve satisfactory alignment.
Two patients who underwent open reduction presented
with delayed union (as a result of prior treatment) or had
nonsignificant radiographic signs of healing 3 months
after the index surgery.
Neither patient had an associated elbow dislocation.

Open reduction internal fixation of lateral humeral condyle fractures in children. A

series of 105 fractures from a single institution

Strategies in Trauma and Limb Recons

truction
August 2014,Volume 9,Issue 2,pp
73-78,

 One hundred and five lateral condyle

fractures were identified in 76 male and 29
female patients. Average age was 6.2years.
Average time to radiological union was
33days.
The aim of the present study was to review
the results of patients with a displaced
lateral humeral condyle fracture treated with
open reduction and internal fixation (ORIF).

Results
Radiological hypertrophy of the lateral condyle
was present in 45 cases (42 %).
Three patients developed a pseudo-cubitus
varus deformity.
Further four patients developed a true cubitus
varus.
There was one case of superficial infection of the
K-wires and one case of delayed union.
At the latest follow-up, 96 % of the patients
achieved an excellent final result and 4 % a good
final result.

Closed Reduction and Internal Fixation of Displaced

Unstable Lateral Condylar Fractures of the Humerus in
Children

Kwang SoonSong,MD;Chul HyungKang,MD;Byung

WooMin,MD;Ki CheorBae,MD;Chul HyunCho,MD;Ju
HyubLee,MD
J Bone Joint Surg Am,2008 Dec 01;90(12):2673-2681.
http://dx.doi.org/10.2106/JBJS.G.01227

Methods:
We prospectively treated sixty-three
unstable and assessed the quality of
closed reduction.

Results:
Thirteen of seventeen stage-3 fractures were
reduced to 1 mm of residual displacement. Thirty
of forty stage-4 fractures and three of six stage-5
fractures were reduced to 2 mm of displacement.
In ten of forty stage-4 fractures and three of six
stage-5 fractures, closed reduction to within 2 mm
failed and open reduction and internal fixation was
performed. There were no major complications
such as osteonecrosis of the trochlea or capitellum,
nonunion, malunion, or early physeal arrest.

Conclusions
Closed reduction and internal fixation is an
effective treatment for unstable displaced
lateral condylar fractures of the humerus in
many children. If fracture displacement
after closed reduction exceeds 2 mm,
open reduction and internal fixation is
recommended.

Surgery for nonunion of the lateral

humeral condyle in children
Acta Orthop Scand 1995; 66 (5):
401-402

 Between 1984 and 1993, 6 children

with a posttraumatic established
nonunion of the lateral humeral
condyle were treated. The nonunion
was diagnosed clinically-the
fragment was palpable and
mobileand was demonstrated
radiographically.

 The nonunion was exposed through a lateral

approach. An incision was made along the
lateral border of the distal humerus to below the
lateral condyle along the posterior lateral
surface of the forearm.
The condylar fragment was replaced in its
original location and fixed with 2 small screws
providing compression across the fracture site.
Autologous bone grafts from the iliac crest or
proximal ulna were placed on the surface of the
pseudarthrosis.

Results
All nonunions united. There were no
cases of avascular necrosis. A lateral
condylar spur formation was
radiographically visible in 3 cases but
had no cosmetic or functional
significance. All patients were
painfree. The range of motion was
unchanged or improved in all cases.

Distal humerus lateral condyle fracture in children:

When is the conservative treatment a valid option?

Revue de Chirurgie Orthopdique et

Traumatologique,Volume 97, Issue
3,May 2011,Pages 290-294

Materials and methods

Twenty-two children who had
sustained lateral humeral condyle
fracture between January 2007 and
January 2010 were reviewed in April
2010. At this consultation, the
children underwent clinical and
radiological examination.

Results
Conservative treatment was
exclusive to cases of lateral condyle
displacement equal to or less than
1mm. All other fractures were
managed by surgical open reduction
and fixation using cross-pinning.
There was no statistically significant
difference in clinical or radiological
outcome between conservative and
surgical management.

Discussion
Lateral humeral condyle fracture is difficult
to diagnose in children.
The majority of poor results reported in
literature relate to inadequate initial
treatment.
Given a radiological aspect of hemarthrosis
of the elbow, the emergency physician
prescribes multiple X-ray views of the
affected elbow.

Lateral Condyle Fracture of the Humerus in Children

Treated with Bioabsorbable Materials

The Scientific World Journal

Volume2013(2013), Article
ID869418, 5 pages

 16 children with similar fractures and

ages were grouped according to the
fixation mate
Twelve children had a sufficient
followup and could be included in the
study.rial used.

 From January 2008 to December 2009, 16 children

underwent surgical treatment of a lateral condyle
fracture of the elbow in our pediatric orthopaedic
and trauma unit. The first group (group 1) consisted
of 10 children operated in 2008 using traditional
metallic K-wires for fixation after open anatomical
reduction. Each child required a second operation
for hardware removal 6 to 8 weeks after trauma.
In 2009, 6 children with similar fractures constituted
group 2 and were treated using bioabsorbable pins
and/or screws with the same surgical approach.

Conclusion
When compared to metal fixation, bioabsorbable
fixation of lateral condyle fractures of the elbow was
safe. It also is costeffective when for hardware removal,
a second anaesthetic is planned.
No clinically relevant specific complication or adverse
reaction could be attributed directly to the
bioabsorbable material. More than four years after
surgery, the functional outcome was excellent.
Nonsignificant radiographic bone modifications around
the fracture were noted in both groups. Using
bioabsorbable material for the surgical treatment of
lateral condyle fractures of the elbow appeared as a
satisfying alternative to metal K-wires.