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Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls

International Orthopaedics volume 41, pages 1453–1461 (2017)Cite this article

Abstract

Introduction

Lateral humeral condylar fractures are the second most common elbow fractures in children. We present the long-term clinical and radiographic results.

Material and methods

All children (<16 years) in the geographic catchment area with lateral condylar fracture were asked to participate and 32 (76.2%) patients enrolled. Clinical and functional results are compared with randomly selected but age and sex matched normal controls at 12.4 years (range 10.6 to 16.0).

Results

Unsatisfactory clinical outcomes were found in 40.6% of the fracture cases vs. 6.3% controls (P = 0.003), according to Flynn’s criteria. Flexion-extension range of motion was decreased >5° in 13 cases (40.6%) and in four controls (12.5%, P = 0.013). One in four (N = 8, 25%) of the cases showed cubitus varus >5° and 15.7% (N = 5) had cubitus valgus >5°, compared to one cubitus valgus (3.1%) in controls (P = 0.002).

Conclusion

The majority of the adolescent and young adult patients (59.4%) with a previous paediatric lateral humeral condylar fracture had recovered well and showed good or excellent overall outcomes according to Flynn’s criteria for elbow assessment after a mean of 12.4 years post-injury. Long-term sequelae was unchanged regardless of treatment.

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References

  1. Tejwani N, Phillips D, Goldstein RY (2011) Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg 19:350–358

    Article  PubMed  Google Scholar 

  2. Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J (2015) Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 1–6

  3. Landin LA (1983) Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a swedish urban population 1950–1979. Acta Orthop Scand Suppl 202:1–109

  4. Kim SS, Kim HJ, Kim HH, Seok SY, Jung SY (2015) The changes in patient pattern for pediatric supracondylar and lateral condylar humeral fractures. J Korean Orthop Assoc 50:132–136

    Article  Google Scholar 

  5. Landin LA, Danielsson LG (1986) Elbow fractures in children: an epidemiological analysis of 589 cases. Acta Orthop 57:309–312

    CAS  Article  Google Scholar 

  6. Salonen A, Pajulo O, Lahdes-Vasama T, Välipakka J, Mattila V (2013) Increased incidence of distal humeral fractures and surgical treatment in 0-to 18-year-old patients treated in finland from 1987 to 2010. J Child Orthop 7:559–564

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Chen FS, Diaz VA, Loebenberg M, Rosen JE (2005) Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Orthop Surg 13:172–185

    Article  PubMed  Google Scholar 

  8. Cates RA, Mehlman CT (2012) Growth arrest of the capitellar physis after displaced lateral condyle fractures in children. J Pediatr Orthop 32:e57–62. doi:10.1097/BPO.0b013e31826bb0d5

    Article  PubMed  Google Scholar 

  9. Marcheix P, Vacquerie V, Longis B, Peyrou P, Fourcade L, Moulies D (2011) Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option? Orthop Traumatol Surg Res 97:304–307

    Article  PubMed  Google Scholar 

  10. Sullivan AJ (2006) Fractures of the lateral condyle of the humerus. J Am Acad Orthop Surg 14:58–62

    Article  PubMed  Google Scholar 

  11. Bhandari M, Tornetta P, Swiontkowksi MF (2003) Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma 17:306–308

    Article  PubMed  Google Scholar 

  12. Vallila N, Sommarhem A, Paavola M, Nietosvaara Y (2015) Pediatric distal humeral fractures and complications of treatment in finland: a review of compensation claims from 1990 through 2010. J Bone Joint Surg Am 97:494–499. doi:10.2106/JBJS.N.00758

    Article  PubMed  Google Scholar 

  13. Mizuta T, Benson W, Foster B, Morris L (1987) Statistical analysis of the incidence of physeal injuries. J Pediatr Orthop 7:518–523

    CAS  Article  PubMed  Google Scholar 

  14. Bernthal NM, Hoshino CM, Dichter D, Wong M, Silva M (2011) Recovery of elbow motion following pediatric lateral condylar fractures of the humerus. J Bone Joint Surg Am 93:871–877. doi:10.2106/JBJS.J.00935

    Article  PubMed  Google Scholar 

  15. Launay F, Leet AI, Jacopin S, Jouve J, Bollini G, Sponseller PD (2004) Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Pediatr Orthop 24:385–391

    Article  PubMed  Google Scholar 

  16. So Y, Fang D, Orth MC, Leong J, Bong S (1985) Varus deformity following lateral humeral condylar fractures in children. J Pediatr Orthop 5:569–572

    CAS  Article  PubMed  Google Scholar 

  17. Skak SV, Olsen SD, Smaabrekke A (2001) Deformity after fracture of the lateral humeral condyle in children. J Pediatr Orthop B 10:142–152

    CAS  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  19. Thomas DP, Howard AW, Cole WG, Hedden DM (2001) Three weeks of kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop 21:565–569

    CAS  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  21. Hasler C, 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 

  22. Koh KH, Seo SW, Kim KM, Shim JS (2010) Clinical and radiographic results of lateral condylar fracture of distal humerus in children. J Pediatr Orthop 30:425–429. doi:10.1097/BPO.0b013e3181df1578

    Article  PubMed  Google Scholar 

  23. Flynn JC (1989) Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop 9:691–696

    CAS  Article  PubMed  Google Scholar 

  24. Pribaz JR, Bernthal NM, Wong TC, Silva M (2012) Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop 32:456–460. doi:10.1097/BPO.0b013e318259ff63

    Article  PubMed  Google Scholar 

  25. Wang YL, Chang WN, Hsu CJ, Sun SF, Wang JL, Wong CY (2009) The recovery of elbow range of motion after treatment of supracondylar and lateral condylar fractures of the distal humerus in children. J Orthop Trauma 23:120–125. doi:10.1097/BOT.0b013e318193c2f3

    Article  PubMed  Google Scholar 

  26. Sinikumpu JJ (2015) Too many unanswered questions in children’s forearm shaft fractures: high-standard epidemiological and clinical research in pediatric trauma is warranted. Scand J Surg 104:137–138. doi:10.1177/1457496915594285

    Article  PubMed  Google Scholar 

  27. Leonidou A, Chettiar K, Graham S, Akhbari P, Antonis K, Tsiridis E, Leonidou O (2014) Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution. Strateg Trauma Limb Reconstr 9:73–78

    Article  Google Scholar 

  28. Pennington R, Corner J, Brownlow H (2009) Milch’s classification of paediatric lateral condylar mass fractures: analysis of inter-and intraobserver reliability and comparison with operative findings. Injury 40:249–252

    CAS  Article  PubMed  Google Scholar 

  29. Flynn JC, Matthews JG, Benoit RL (1974) Blind pinning of displaced supracondylar fractures of the humerus in children. sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 56:263–272

    CAS  Article  PubMed  Google Scholar 

  30. Beals RK (1976) The normal carrying angle of the elbow. A radiographic study of 422 patients. Clin Orthop Relat Res 119:194–196

    Google Scholar 

  31. Sinikumpu J, Victorzon S, Pokka T, Lindholm E, Peljo T, Serlo W (2016) The long-term outcome of childhood supracondylar humeral fractures. Bone Joint J 98:1410–1417

    Article  PubMed  Google Scholar 

  32. Crosby CA, Wehbé MA (1994) Hand strength: normative values. J Hand Surg 19:665–670

    CAS  Article  Google Scholar 

  33. Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW (2014) Accuracy and reliability of the mayo elbow performance score. J Hand Surg 39:1146–1150

    Article  Google Scholar 

  34. de Boer YA, Hazes JM, Winia PC, Brand R, Rozing PM (2001) Comparative responsiveness of four elbow scoring instruments in patients with rheumatoid arthritis. J Rheumatol 28:2616–2623

    PubMed  Google Scholar 

  35. Duruöz MT (2014) Hand function: a practical guide to assessment. Springer, Berlin

  36. Lehtinen JT, Kaarela K, Belt EA, Kauppi MJ, Skytta E, Kuusela PP, Kautiainen HJ, Lehto MU (2001) Radiographic joint space in rheumatoid elbow joints. A 15-year prospective follow-up study in 74 patients. Rheumatology (Oxford) 40:1141–1145

    CAS  Article  Google Scholar 

  37. Van Vugt A, Severijnen R, Festen C (1988) Fractures of the lateral humeral condyle in children: late results. Arch Orthop Trauma Surg 107:206–209

    Article  PubMed  Google Scholar 

  38. Ippolito E, Tudisco C, Farsetti P, Caterini R (1996) Fracture of the humeral condyles in children: 49 cases evaluated after 18–45 years. Acta Orthop Scand 67:173–178

    CAS  Article  PubMed  Google Scholar 

  39. Bauer AS, Bae DS, Brustowicz KA, Waters PM (2013) Intra-articular corrective osteotomy of humeral lateral condyle malunions in children: early clinical and radiographic results. J Pediatr Orthop 33:20–25. doi:10.1097/BPO.0b013e318279c4cd

    Article  PubMed  Google Scholar 

  40. France J, Strong M (1992) Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop 12:494–498

    CAS  Article  PubMed  Google Scholar 

  41. Salgueiro L, Roocroft JH, Bastrom TP, Edmonds EW, Pennock AT, Upasani VV, Yaszay B (2015) Rate and risk factors for delayed healing following surgical treatment of lateral condyle humerus fractures in children. J Pediatr Orthop. doi:10.1097/BPO.0000000000000578

    Google Scholar 

  42. Park H, Hwang JH, Kwon YU, Kim HW (2015) Osteosynthesis in situ for lateral condyle nonunion in children. J Pediatr Orthop 35:334–340. doi:10.1097/BPO.0000000000000353

    Article  PubMed  Google Scholar 

  43. Morris S, McKenna J, Cassidy N, Stephens M (2000) A new technique for treatment of a non-union of a lateral humeral condyle. Injury 31:557–559

    CAS  Article  PubMed  Google Scholar 

  44. Schneeberger AG, Kösters MC, Steens W (2014) Comparison of the subjective elbow value and the mayo elbow performance score. J Shoulder Elbow Surg 23:308–312

    Article  PubMed  Google Scholar 

  45. Busse JW, Obremskey WT (2009) Principles of designing an orthopaedic case–control study. J Bone Joint Surg Am 91(Suppl 3):15–20. doi:10.2106/JBJS.H.01570

    Article  PubMed  Google Scholar 

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Author information

Affiliations

  1. Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu University, Medical Research Center Oulu, PEDEGO Research Group, P.o. BOX 23, FIN-90029 OYS, Oulu, Finland

    Juha-Jaakko Sinikumpu, Tytti Pokka & Willy Serlo

  2. Department of Radiology, Vaasa Central Hospital, Vaasa, Finland

    Sarita Victorzon

  3. Department of Radiology, Oulu University Hospital, Oulu, Finland

    Eija-Leena Lindholm

Authors
  1. Juha-Jaakko Sinikumpu
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  2. Tytti Pokka
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  3. Sarita Victorzon
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  4. Eija-Leena Lindholm
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  5. Willy Serlo
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Corresponding author

Correspondence to Juha-Jaakko Sinikumpu.

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Conflict of interests

The authors declare that they have no conflict of interest.

Funding

This study was supported by Alma and K.A. Snellman Foundation, Vaasa Foundation of Physicians, The Finnish Medical Foundation, The Emil Aaltonen Foundation, Finska Läkaresällskapet Foundation, the Medical Society of Finland and Foundation for Pediatric Research.

Ethical approval

The Ethics Committee of Oulu University Hospital approved the study prior to its initiation (§2008-05-26). Informed consent was obtained from all participants and/or their parents/guardians before inclusion. The study was carried out in compliance with the Helsinki Declaration of 1983.

Informed consent

Informet consent was obtained from all individual participants included in the study.

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Sinikumpu, JJ., Pokka, T., Victorzon, S. et al. Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls. International Orthopaedics (SICOT) 41, 1453–1461 (2017). https://doi.org/10.1007/s00264-017-3451-0

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  • DOI: https://doi.org/10.1007/s00264-017-3451-0

Keywords

  • Long-term outcome
  • Children
  • Humeral fracture
  • Lateral condyle