Twenty-degree-tilt radiography for evaluation of lateral humeral condylar fracture in children

Abstract

Objective

To investigate the efficacy of ‘20°-tilt anteroposterior (A-P) radiography’ in the assessment of lateral condylar fractures of the distal humerus.

Materials and methods

Eighteen children with lateral humeral condylar fractures were studied. Every child underwent conventional A-P and lateral radiography, and six children underwent multi-detector computed tomography (MDCT). For the investigation of 20°-tilt radiography, ten children with lateral humeral condylar fractures had conventional and 20°-tilt A-P and lateral radiography both preoperatively and postoperatively. Fragment dislocation was measured at the lateral and medial margins of the fracture on both the conventional A-P and 20°-tilt A-P radiographs.

Results

The lateral condylar fragment was triangular and was most prominent posteriorly. The fracture line was typically tilted approximately 20° to a reference line perpendicular to the long axis of the humerus in the lateral view. The extent of dislocation at the lateral and medial margins of the fracture site by 20°-tilt A-P radiography (9.3 ± 3.6 mm and 5.6 ± 2.5 mm) was significantly wider than that measured by the conventional method (6.8 ± 4.1 mm and 2.0 ± 1.5 mm ), which may influence treatment.

Conclusion

Twenty-degree-tilt A-P radiography may more precisely demonstrate fragment dislocation than standard radiographs and may influence patient treatment.