Skip to main content
SpringerLink
Log in

Therapieprinzipien und Outcome nach Frakturen des Condylus radialis im Wachstumsalter

Treatment principles and outcome after fractures of the lateral humeral condyle in children

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Differenzierung von komplett und inkomplett artikulären Frakturen des Condylus radialis bereitet Schwierigkeiten. Das Ziel dieser Arbeit war deshalb die Analyse der Therapie in Abhängigkeit vom initialen Dislokationsausmaß sowie der Frakturstabilität im Verlauf der Behandlung.

Material und Methode

Retrospektive Datenanalyse aller behandelten Condylus-radialis-Frakturen bei Kindern <16 Jahre zwischen 2005 und 2014. Klassifiziert wurden die Patienten nach der Frakturstabilität zum Unfallzeitpunkt (primär stabil oder instabil) und im Verlauf nach 4 Tagen (sekundär stabil oder instabil) durch ein konventionelles Röntgenbild.

Ergebnisse

Es wurden 89 Frakturen des Condylus radialis (∅-Alter 6,4 Jahre [0,9–14]) behandelt. Davon waren 52 (58 %) primär undisloziert und 37 (42 %) disloziert. Letztere wurden offen reponiert und per Osteosynthese stabilisiert („primär instabil“). Von den 52 initial undislozierten Frakturen konnten 35 Frakturen bei im Verlauf ausbleibender Dislokation konservativ in einer Gipsschiene therapiert werden („primär und sekundär stabil“). Acht der 52 Frakturen dislozierten nach durchschnittlich 6 Tagen (3–10) und wurden operativ behandelt („primär stabil und sekundär instabil“). Zwei der 52 Frakturen wurden nicht zur Röntgenkontrolle vorstellig und zeigten am Therapieende eine disloziert verheilte Fraktur („primär stabil und sekundär instabil“). Sieben der 52 Frakturen waren initial undisloziert („primär stabil“), wurden jedoch trotzdem operiert („Übertherapie“). Das Outcome war vergleichbar mit den Angaben in der Literatur.

Schlussfolgerung

Der Therapieentscheid bei der Condylus-radialis-Fraktur richtet sich nach der primären und sekundären Frakturstabilität, die zweizeitig mittels Röntgenbildern ermittelt wird. Stabile Frakturen – ob komplett und inkomplett artikulär – können konservativ therapiert werden und sollten keine Übertherapie erfahren. Instabile Frakturen – ob primär oder sekundär im Verlauf – müssen als solche erkannt werden und operativ mit einer stabilen Osteosynthese behandelt werden.

Abstract

Background

Fractures of the lateral humeral condyle with displacement (>2 mm; <2 mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive X‑rays.

Material and methods

A retrospective data analysis of all lateral humeral condyles in children <16 years old treated between 2005 and 2014 was carried out. The patients were classified according to the fracture stability at the time of the incident (primarily stable or unstable) and after 4 days (secondarily stable or unstable) using conventional X‑ray images.

Results

A total of 89 fractures of the lateral humeral condyle were treated (mean age 6.4 years, range 0.9–14 years). Of the fractures 52 (58%) were initially not displaced and 37 (42%) were initially displaced. The latter underwent open reduction and stabilization by osteosynthesis (primarily stable). Of the 52 initially not displaced fractures 35 remained stable and conservative treatment in a plaster cast was performed (primarily and secondarily stable). In 8 out of 52 cases a secondary displacement (>2 mm articular gap) occurred after an average of 6 days (range 3–10 days) and operative treatment was initiated (primarily stable and secondarily unstable). No follow-up x‑ray could be performed in 2 of the 52 fractures and at the end of treatment the fractures healed with displacement (primarily stable and secondarily unstable). In 7 of the 52 fractures operative treatment was performed although no displacement (primarily stable) was initially documented (overtreatment). The outcome of the whole study cohort was comparable with that described in the literature.

Conclusion

Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with a stable osteosynthesis must be initiated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Andrey V, Tercier S, Vauclair F et al (2013) Lateral condyle fracture of the humerus in children treated with bioabsorbable materials. ScientificWorldJournal. https://doi.org/10.1155/2013/869418

    Article  PubMed  PubMed Central  Google Scholar 

  2. Badelon O, Bensahel H, Mazda K et al (1988) Lateral humeral condylar fractures in children: a report of 47 cases. J Pediatr Orthop 8:31–34

    Article  CAS  Google Scholar 

  3. Bernthal NM, Hoshino CM, Dichter D et al (2011) Recovery of elbow motion following pediatric lateral condylar fractures of the humerus. J Bone Joint Surg Am 93:871–877

    Article  Google Scholar 

  4. Bloom T, Chen LY, Sabharwal S (2011) Biomechanical analysis of lateral humeral condyle fracture pinning. J Pediatr Orthop 31:130–137

    Article  Google Scholar 

  5. Burnier M, Buisson G, Ricard A et al (2016) Diagnostic value of ultrasonography in elbow trauma in children: prospective study of 34 cases. Orthop Traumatol Surg Res 102:839–843

    Article  CAS  Google Scholar 

  6. Fernandez FF, Eberhardt O, Von Kalle T et al (2009) Kirschner wire fixation for fractures of the radial condyle in children and adolescents. Obere Extremität 4:26–32

    Article  Google Scholar 

  7. Finnbogason T, Karlsson G, Lindberg L et al (1995) Nondisplaced and minimally displaced fractures of the lateral humeral condyle in children: a prospective radiographic investigation of fracture stability. J Pediatr Orthop 15:422–425

    Article  CAS  Google Scholar 

  8. Hasler C, Von Laer L (1998) Screw osteosynthesis in dislocated fractures of the radial condyle of the humerus in the growth period. A prospective long-term study. Unfallchirurg 101:280–286

    Article  CAS  Google Scholar 

  9. Hasler CC, Von Laer L (2001) Prevention of growth disturbances after fractures of the lateral humeral condyle in children. J Pediatr Orthop B 10:123–130

    CAS  PubMed  Google Scholar 

  10. Jakob R, Fowles JV, Rang M et al (1975) Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br 57:430–436

    Article  CAS  Google Scholar 

  11. Kamegaya M, Shinohara Y, Kurokawa M et al (1999) Assessment of stability in children’s minimally displaced lateral humeral condyle fracture by magnetic resonance imaging. J Pediatr Orthop 19:570–572

    CAS  PubMed  Google Scholar 

  12. Linden HP, Würtenberger H (1977) Ungewöhnlicher Heilungsverlauf bei Fraktur des Condylus radialis humeri. Z Kinderchir 20:375–378

    Google Scholar 

  13. Marzo JM, D’amato C, Strong M et al (1990) Usefulness and accuracy of arthrography in management of lateral humeral condyle fractures in children. J Pediatr Orthop 10:317–321

    Article  CAS  Google Scholar 

  14. Milch H (1964) Fractures and fracture dislocations of the humeral condyles. J Trauma 4:592–607

    Article  CAS  Google Scholar 

  15. Milch H (1956) Fractures of the external humeral condyle. J Am Med Assoc 160:641–646

    Article  CAS  Google Scholar 

  16. Pirker ME, Weinberg AM, Hollwarth ME et al (2005) Subsequent displacement of initially nondisplaced and minimally displaced fractures of the lateral humeral condyle in children. J Trauma 58:1202–1207

    Article  Google Scholar 

  17. Silva M, Paredes A, Sadlik G (2017) Outcomes of ORIF >7 days after injury in displaced pediatric lateral condyle fractures. J Pediatr Orthop 37:234–238

    Article  Google Scholar 

  18. Slongo T, Audige L, Schlickewei W et al (2006) Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J Pediatr Orthop 26:43–49

    Article  Google Scholar 

  19. Spiegel PG, Cooperman DR, Laros GS (1978) Epiphyseal fractures of the distal ends of the tibia and fibula. A retrospective study of two hundred and thirty-seven cases in children. J Bone Joint Surg Am 60:1046–1050

    Article  CAS  Google Scholar 

  20. Spiegel PG, Mast JW, Cooperman DR et al (1984) Triplane fractures of the distal tibial epiphysis. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-198409000-00010

    Article  PubMed  Google Scholar 

  21. Tarczynska M, Kolodziej R, Gagala J (2007) Results of operative treatment for ulnar neuropathy in patients with a history of fracture of the lateral part of the humeral condyle in childhood. Ortop Traumatol Rehabil 9:75–81

    PubMed  Google Scholar 

  22. Temporin K, Namba J, Okamoto M et al (2015) Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res 101:593–596

    Article  CAS  Google Scholar 

  23. Thonell S, Mortensson W, Thomasson B (1988) Prediction of the stability of minimally displaced fractures of the lateral humeral condyle. Acta Radiol 29:367–370

    Article  CAS  Google Scholar 

  24. Vocke-Hell AK, Schmid A (2001) Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children. J Pediatr Orthop B 10:138–141

    CAS  PubMed  Google Scholar 

  25. Von Laer L (1981) Fracture of condylus radialis humeri during skeletal growth. Arch Orthop Trauma Surg 98:275–283 (author’s transl)

    Article  Google Scholar 

  26. Von Laer L et al (2000) Classification and documentation of children’s fractures. Eur J Trauma 26:2–14

    Article  Google Scholar 

  27. Von Laer LR (1998) Fracture of the radial condyle of the humerus in the growth period. Unfallchirurg 101:271–279

    Article  Google Scholar 

  28. Weiss JM, Graves S, Yang S et al (2009) A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 29:602–605

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    J. Lieber, M. Dietzel, H.-J. Kirschner & J. Fuchs

  2. Abteilung für Diagnostische und Interventionelle Radiologie, Bereich Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    I. Tsiflikas & J. Schäfer

Authors
  1. J. Lieber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Dietzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Tsiflikas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.-J. Kirschner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Lieber.

Ethics declarations

Interessenkonflikt

J. Lieber, M. Dietzel, I. Tsiflikas, J. Schäfer, H.-J. Kirschner und J. Fuchs geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Die retrospektive Datenanalyse wurde von der Ethikkommission der Eberhard-Karls-Universität Tübingen genehmigt (Projekt-Nummer 855/2018BO2).

Additional information

Redaktion

P. Schmittenbecher, Karlsruhe

W. Mutschler, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lieber, J., Dietzel, M., Tsiflikas, I. et al. Therapieprinzipien und Outcome nach Frakturen des Condylus radialis im Wachstumsalter. Unfallchirurg 122, 345–352 (2019). https://doi.org/10.1007/s00113-019-0605-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-019-0605-0

Schlüsselwörter

Keywords

Search

Navigation