Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

Background Evaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment. Methods Thirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared. Results The mean displacement of the fractures was 3.1 mm (range, 2.0~5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures. Level of evidence Prospective study; level II.

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

Background: Evaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment.Methods: Thirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared.Results: The mean displacement of the fractures was 3.1 mm (range, 2.0～5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837.Conclusions: Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures.Level of evidence: Prospective study; level Ⅱ.

Ultrasound Versus Arthrography in Diagnosing the Stability of Minimally Displaced Lateral Humeral Condyle Fractures in Children

Background: The evaluation of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound of the elbow is increasingly used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children in minimally displaced fractures. The aim of this study was to assess the correlation between ultrasound with arthrography for predicting the integrity of the cartilage hinge and describe the utility of ultrasound in directing the need for pre-treatment. Methods: 39 patients with minimally displaced lateral humeral condyle fractures and underwent ultrasound and arthrography examinations before operation from May 2018 to December 2019 were included in this study. The ultrasound and arthrography predictors of the cartilage hinge status were independently measured. Result of ultrasound and arthrography were compared.Results: The mean displacement of fractures was 3.1 mm (range, 2.0～5.0 cm). The arthrography showed an incomplete fracture in 24 patients (61.5%) and complete in 15 patients (38.5%). The ultrasound showed an incomplete fracture in 25 patients (64.1%) and complete in 14 patients (35.9%). The ultrasound and arthrography evaluations of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 were predicted to have an intact articular surface, and 13 were predicted to have incongruity articular surface. There was no correlation between displacement and the fracture being complete on ultrasound. The Pearson coefficient value of ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions: Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status of patients with minimally displaced lateral humeral condyle fractures in children.Level of evidence: Retrospective study; level Ⅳ.

Solitary Epiphysial Enchondroma of the Proximal Humerus Causing Growth Deficiency in a 13-Year-Old Boy Lengthened over Intramedullary Nail

A 13-year-old boy complained of shortness of his left arm with the desire for lengthening. The X-Ray showed the enlarged ellipsoid shaped humeral epiphysis in varus position and irregular joint surface. The MRI documented a distorted bone structure involving the complete epiphysis, overgrowth of the tuberosities and partial closure of the physis. MR-angiography revealed normally appearing vessel formation; however, a biopsy was recommended to rule out a vascular malformation. A tru-cut needle biopsy confirmed the diagnosis of enchondromatous changes. As the patient felt strongly disturbed by the shortness of his arm, lengthening was performed using the fully inserted magnetic driven PreciceR nail. Conclusion: This case is of interest as epiphysial enchondromas are rare and complete involvement of the proximal humeral epiphysis causing growth deficiency to our knowledge has never been described before. Lengthening using a device penetrating the cartilaginous region is debatable; however, so far, sarcomatous dedifferentiation in epiphysial enchondromas has not been described.