Early Versus Late Removal of Internally Fixated Kirschner’s Wires for Displaced Lateral Condyle Fracture of Humerus in Children

Introduction: Lateral condyle fracture of the distal humerus is the second most common paediatric elbow fracture. Unstable, rotated and displaced (>2 mm) fractures are managed with open reduction and internal fixation with Kirschner’s wires or screws. Debate persists as for how long the Kirschner’s wires should be placed in situ after internal fixation. We aimed to compare the functional and radiological outcome after early versus late removal of internally fixated Kirschner’s wires for displaced lateral condyle fracture of distal humerus. Methods: Children that underwent early (3-4 weeks) or late (5-7 weeks) removal of Kirschner’s wire after open reduction and internal fixation for displaced lateral condyle fracture of humerus were observed for a period of minimum 6 months. Time to radiological union, carrying angle, range of motion was assessed and compared between early and late group. Functional outcome was compared using the Dhillon scoring system. Results: We report the outcome of 40 cases (20 cases in each early and late group). Radiological union was achieved in all the cases of both group at 12 weeks follow up. The mean loss of carrying angle was statistically insignificant (p = 0.394) between the early and late group. There was no significant difference between the early and late group in relation to arc of motion at 12 weeks (p=0.724) and 6 months (p=0.638) follow up. Using the Dhillon scoring system, there was 100% excellent Dhillon score in early group, 80% excellent and 20% good Dhillon score in late group. Functional outcome was statistically insignificant between the two groups (p = 0.106) Conclusion: Early removal of internally fixated K-wires for displaced lateral condyle fracture of humerus in children showed similar radiological and functional results to late removal.

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Paediatric lateral condyle fracture with a posterolateral elbow dislocation: an atypical injury in a preadolescent

BMJ Case Reports ◽

10.1136/bcr-2021-241725 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241725

Author(s):

Bradley D Wiekrykas ◽

Nancy Campbell ◽

Dustin A Greenhill

Keyword(s):

Functional Limitations ◽

Elbow Dislocation ◽

Distal Humerus ◽

Fracture Dislocation ◽

Lateral Condyle ◽

Elbow Fracture ◽

Rare Injury ◽

Lateral Condyle Fracture ◽

Carrying Angle ◽

Condyle Fracture

Paediatric lateral condyle fractures of the distal humerus are common but a concomitant elbow dislocation is rare. Typically, paediatric orthopaedic surgeons will treat lateral condyle fractures with pin or metaphyseal single-screw fixation and supplementary immobilisation for several weeks. These techniques sacrifice the early stability and mobilisation necessary to avoid stiffness after a complex elbow fracture-dislocation. We present an 11-year-old boy who sustained a traumatic posterolateral elbow dislocation with lateral condyle and coronoid fractures. Due to advanced skeletal age, both paediatric and adult treatment principles were applied to this rare injury. After initial closed reduction, open reduction and internal fixation of the distal humerus lateral condyle with divergent partially threaded compression screws was performed. Motion was initiated in 2 weeks and the patient regained almost full motion by 3 months. At 1.5-year follow-up, the affected limb carrying angle was unaffected and the patient had no functional limitations.

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Nonunion of a Pediatric Lateral Condyle Fracture Without Ulnar Nerve Palsy: Sixty-Year Follow-Up

Journal of Orthopaedic Trauma ◽

10.1097/00005131-199908000-00011 ◽

1999 ◽

Vol 13 (6) ◽

pp. 456-458 ◽

Cited By ~ 8

Author(s):

Steven J. Morgan ◽

Walter B. Beaver

Keyword(s):

Ulnar Nerve ◽

Nerve Palsy ◽

Lateral Condyle ◽

Lateral Condyle Fracture ◽

Ulnar Nerve Palsy ◽

Condyle Fracture

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A Clinical Study of Lateral Condyle Fracture of Distal Humerus in Children

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1988.23.4.1039 ◽

1988 ◽

Vol 23 (4) ◽

pp. 1039

Author(s):

Bong Yeol Lim ◽

Hee Young Cheong ◽

Byung Ryoung Yoo ◽

Dong Bai Shin

Keyword(s):

Clinical Study ◽

Distal Humerus ◽

Lateral Condyle ◽

Lateral Condyle Fracture ◽

Condyle Fracture

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Lateral Condyle Fracture of Tibia Treated by Open Reduction and Internal Fixation

Journal of the Korean Fracture Society ◽

10.12671/jksf.1996.9.1.137 ◽

1996 ◽

Vol 9 (1) ◽

pp. 137

Author(s):

Jong-Min Sohn ◽

Ju-Hai Chang ◽

Dong-Heon An ◽

Soo-An Park

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Lateral Condyle ◽

Lateral Condyle Fracture ◽

Condyle Fracture

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Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

The Scientific World JOURNAL ◽

10.1155/2013/869418 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Véronique Andrey ◽

Stéphane Tercier ◽

Frédéric Vauclair ◽

Aline Bregou-Bourgeois ◽

Nicolas Lutz ◽

...

Keyword(s):

Clinical Results ◽

Lateral Condyle ◽

Radiological Outcome ◽

Traditional Use ◽

Traditional Group ◽

Metallic Material ◽

Lateral Condyle Fracture ◽

Clinical And Radiological Outcome ◽

Condyle Fracture

The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months) postoperatively. The clinical results were compared using theMayo Elbow Performance Score(MEPS). Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children.

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Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i6.25727 ◽

2019 ◽

Vol 10 (6) ◽

pp. 75-79

Author(s):

Pabin Thapa ◽

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pratyenta Raj Onta ◽

...

Keyword(s):

Internal Fixation ◽

P Value ◽

Lateral Condyle ◽

Kirschner Wires ◽

Lateral Condyle Fracture ◽

The Mean ◽

K Wires ◽

Condyle Fracture ◽

Humeral Condyle ◽

Screw Group

Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow. Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children. Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al. Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022). Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

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Outcome of Lateral Condyle Fracture of Humerus in Children Treated with Open Reduction and Internal Fixation

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v17i2.28754 ◽

2019 ◽

Vol 17 (2) ◽

pp. 17-20

Author(s):

Dipendra K.C. ◽

S.M. Mishra ◽

Sushil Yogi ◽

Dinesh Shrestha ◽

Prateek Karki ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

College Teaching ◽

Implant Removal ◽

Lateral Condyle ◽

Type I ◽

Age Group ◽

Lateral Condyle Fracture ◽

K Wires ◽

Condyle Fracture

Introduction: Lateral condyle fracture is one of the commonest injuries encountered in pediatric age group. There is no unanimity regarding the method of treatment, however closed reduction is not applicable to all cases and have failure rates making open reduction and internal fixation (ORIF) as the treatment of choice at least in displaced fractures. There are a number of options during surgical management of these fractures; Kirschner-wire (K-wire) is the most commonly used implant for fixation. The purpose of our study was to evaluate the results of lateral condyle fractures of humerus in children treated by ORIF by K-wires based on Hardacre criteria. Materials: This prospective study was conducted in the department of orthopedics in Nepalgunj Medical College Teaching Hospital, Kohalpur from May 2016 to October 2018. All of the fractures in this study were treated by ORIF with unburied K-wires. It included 37 children of age group upto 14 years. Children were evaluated for age, sex, side of arm involved, mechanism of injury, type of fracture, presence of additional injuries, implant removal time, outcome and accompanying complications. K-wires were removed after clinico-radiological union of the fractures. Patients were evaluated using the Hardacre criteria in follow up till 6 months. Result: In this study of 37 children, 28 (75.7%) were males and 9 (24.3%) were females. All of them were 14 years of age or less with mean age of 6.7 ± 0.316. Majority of fractures (67.6%) were observed between six to ten years of age. Left side was predominantly involved (62.2%). Milch type I fracture was found in 5 (13.5%) children while Milch type II fracture were observed in 32 (86.5%) children. The final outcome and functions were evaluated using Hardacre criteria in which 27 (73%) cases had excellent result and all cases had good result as per Hardacre criteria. The complications were 10 (27%) cases of lateral spur; eight (21.6%) cases of hypertrophied scar and four (10.8%) cases of pin track infection and 2 (5.4%) of cubitus varus. Conclusion: The treatment of displaced lateral condyle fracture of humerus by open reduction and unburied K-wire fixation is safe, easy and cost effective procedure with good results. This modality of treatment provides good results among pediatric population without the need for second admission for implant removal.

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