Si Heng Sharon Tan1, Jo Dartnell2, Andrew Kean Seng Lim2, James Hoipo Hui2. 1. Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119074, Singapore. sharon_sh_tan@nuhs.edu.sg. 2. Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119074, Singapore.
Abstract
INTRODUCTION: Lateral condyle fractures of the humerus are common paediatric fractures. However, no conclusive statement has been made about their risk of complications, the management and epidemiology. MATERIALS AND METHODS: A systematic review was conducted according to PRISMA guidelines. All studies with paediatric lateral condyle fracture were included, with 2440 children. RESULTS: Most fractures had union, with 0.9% delayed union, 1.6% non-union and 1.5% malunion. Complications included valgus deformities (6.1%), varus deformities (7.8%), flexion loss (9.7%), extension loss (11.5%), prominent lateral condyle (27.3%), fishtail deformity (14.3%), avascular necrosis (1.7%), premature epiphyseal closure (5.4%) and neurological deficits (10.6%). Risk factors of complications include concomitant ipsilateral upper limb fractures, classification by Milch or Jakob, fracture displacement, fixation device, and inappropriate diagnosis and management. CONCLUSIONS: It is recommended for fractures that are non-displaced on all radiographic views to be managed conservatively, while displaced fractures of > 2 mm requires surgical intervention. Minimally displaced fractures could be treated conservatively, though follow-up is recommended to detect displacement. Radiographs are also recommended at 1-week follow-up, with serial radiographs having no clinical significance. Kirschner wires or lag screws could be employed, and it is recommended that the Kirschner wires be left exposed and removed when there is clinical and radiographic evidence of fracture consolidation, typically at the 6-week interval. These fractures need close follow-up.
INTRODUCTION: Lateral condyle fractures of the humerus are common paediatric fractures. However, no conclusive statement has been made about their risk of complications, the management and epidemiology. MATERIALS AND METHODS: A systematic review was conducted according to PRISMA guidelines. All studies with paediatric lateral condyle fracture were included, with 2440 children. RESULTS: Most fractures had union, with 0.9% delayed union, 1.6% non-union and 1.5% malunion. Complications included valgus deformities (6.1%), varus deformities (7.8%), flexion loss (9.7%), extension loss (11.5%), prominent lateral condyle (27.3%), fishtail deformity (14.3%), avascular necrosis (1.7%), premature epiphyseal closure (5.4%) and neurological deficits (10.6%). Risk factors of complications include concomitant ipsilateral upper limb fractures, classification by Milch or Jakob, fracture displacement, fixation device, and inappropriate diagnosis and management. CONCLUSIONS: It is recommended for fractures that are non-displaced on all radiographic views to be managed conservatively, while displaced fractures of > 2 mm requires surgical intervention. Minimally displaced fractures could be treated conservatively, though follow-up is recommended to detect displacement. Radiographs are also recommended at 1-week follow-up, with serial radiographs having no clinical significance. Kirschner wires or lag screws could be employed, and it is recommended that the Kirschner wires be left exposed and removed when there is clinical and radiographic evidence of fracture consolidation, typically at the 6-week interval. These fractures need close follow-up.
Authors: Giovanni Trisolino; Diego Antonioli; Giovanni Gallone; Stefano Stallone; Paola Zarantonello; Piergiuseppe Tanzi; Eleonora Olivotto; Luca Stilli; Giovanni Luigi Di Gennaro; Stefano Stilli Journal: Children (Basel) Date: 2021-01-18