دورية أكاديمية
أعرض في EDS

Management of Lateral Condyle Humeral Fracture Associated With Elbow Dislocation in Children. A Retrospective International Multicenter Cohort Study.

التفاصيل البيبلوغرافية
العنوان: Management of Lateral Condyle Humeral Fracture Associated With Elbow Dislocation in Children. A Retrospective International Multicenter Cohort Study.
المؤلفون: Masquijo JJ; Departament of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina., Sanchez Ortiz M; Departament of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina., Ponzone A; Department of Pediatric Orthopaedics, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina., Fernández Korosec L; Department of Pediatric Orthopaedics, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina., Arkader A; Division of Pediatric Orthopaedic Surgery Children's Hospital Philadelphia, PA, USA.
المصدر: Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Feb 01; Vol. 44 (2), pp. 82-88. Date of Electronic Publication: 2023 Nov 20.
نوع المنشور: Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE
أسماء مطبوعة: Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press
مواضيع طبية MeSH: Elbow Joint*/surgery , Humeral Fractures, Distal* , Joint Instability*/etiology , Humeral Fractures*/complications , Humeral Fractures*/surgery , Joint Dislocations*/complications, Male ; Child ; Humans ; Adolescent ; Elbow ; Retrospective Studies ; Humerus/surgery ; Fracture Fixation, Internal/methods ; Range of Motion, Articular ; Necrosis/complications ; Treatment Outcome
مستخلص: Objectives: Lateral humeral condyle fractures account for 12% to 17% of all distal humerus fractures in children, and usually occur as an isolated injury or are associated with radial neck and/or proximal ulna fractures. The presentation with a concomitant dislocation of the elbow is rare. Therefore, literature on young patients with this uncommon combination is sparse and mostly limited to case reports and small case series. The aim of the present study is to identify the best treatment strategy for this injury, recognize potential risk factors for the development of complications, and identify predictors of outcome.
Methods: This is a multicenter retrospective review of electronic and written medical records for skeletally immature patients who were diagnosed with a lateral condyle fracture of the humerus associated with elbow dislocation (ED). Data recorded included patient demographics, fracture classification, direction of the dislocation, treatment strategy, time to union, elbow range of motion, complications, and additional procedures. The modified Flynn criteria were used to determine the outcomes.
Results: We identified 23 patients who presented to 3 institutions with a concomitant lateral humeral condyle fractures and an ED. The mean age at the time of injury was 8.7 years (range: 6 to 13 y). The median time from injury to surgery was 1 day (interquartile range: 0.5, minimum to maximum: 0 to 29 d). The median follow-up was 24 weeks (interquartile range: 16, minimum to maximum: 4 to 120 wk). The injury occurred more commonly in males (79%) with Weiss type 3 fractures. The direction of the dislocation was posterior or posteromedial in most cases. Open reduction through a modified Kocher lateral approach and fixation with either Kirschner wires (N = 12) or cannulated screws (N = 9) was the preferred method of treatment. Eight patients (34.8%) developed complications, including persistent elbow stiffness (N = 5), elbow instability (N = 1), and avascular necrosis (N = 2). There were no cases of delayed union, nonunion, malunion, heterotopic ossification, neurological injury, or hardware failure. Patients treated with casting or Kirschner wire fixation had a significantly increased rate of elbow stiffness compared with screw fixation (50%, 25%, and 11%, respectively, P = 0.015). According to Flynn's criteria, 65% of the patients had good or excellent outcomes, and 35% had poor.
Conclusion: The findings of this study demonstrate a higher than previously described rate of complications in children with lateral condyle humerus fracture associated with ED, including persistent elbow stiffness, avascular necrosis, and chronic elbow instability, leading to unsatisfactory clinical outcomes in over one-third of the cases. Our findings suggest that the internal fixation with screws, combined with a shorter postoperative immobilization period (2 wk) may lead to improved clinical outcomes.
Level of Evidence: Level III-therapeutic, case series.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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تواريخ الأحداث: Date Created: 20231120 Date Completed: 20240109 Latest Revision: 20240109
رمز التحديث: 20240109
DOI: 10.1097/BPO.0000000000002574
PMID: 37982458
قاعدة البيانات: MEDLINE
الوصف
تدمد:1539-2570
DOI:10.1097/BPO.0000000000002574