Vigil James1, Abigail Chin Chii Chng2, Francesca Lim May Ting1, Yiong Huak Chan3, Sashikumar Ganapathy1. 1. From the Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore. 2. Barts and The London School of Medicine and Dentistry, Whitechapel, London, United Kingdom. 3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
Abstract
BACKGROUND: The lateral humeral condyle fractures in children accounts for one fifth of all elbow fractures. These fractures have a propensity to displace because of the pull of the extensor muscles on the condyle. OBJECTIVES: The aim of this study was to examine the epidemiology, injury patterns, complications, and predictors for conservative/surgical management in patients with lateral condyle humeral fractures between 0 and 18 years of age. METHODS: This was a single-center retrospective study conducted between January 2006 and December 2016. RESULTS: There were 268 patients identified with lateral condyle elbow fracture. Majority of the patients (81.4%) with lateral condyle humeral fractures presented with either undisplaced or minimally displaced (<2 mm) fractures. The initial management in majority (90.7%) of the patients was conservative. Of the patients, 26.8% had secondary displacement at follow-up. The overall proportion of patients who required surgical intervention was 36.2%. Varus deformity of elbow (2.2%) and malunion (0.4%) were the complications noticed on long-term follow-up. Increased age and undisplaced fracture were statistically significant positive predictors for conservative management. The presence of concurrent elbow injuries and type of fracture (displaced >2 mm) were statistically significant positive predictors for surgical management. CONCLUSIONS: Our study demonstrated that majority of the patients with lateral condyle humeral fractures had presented with either undisplaced or minimally displaced (<2 mm) fractures. The positive predictors for conservative management of fractures were increased age and undisplaced fracture. The positive predictors for surgical management of lateral condyle humerus fractures were concurrent injuries in elbow and type of fracture (displaced >2 mm). Physician vigilance to the possibility of additional migration of lateral condyle fractures initially managed conservatively, and the need for subsequent surgical stabilization plays an important role in the management of these fractures.
BACKGROUND: The lateral humeral condyle fractures in children accounts for one fifth of all elbow fractures. These fractures have a propensity to displace because of the pull of the extensor muscles on the condyle. OBJECTIVES: The aim of this study was to examine the epidemiology, injury patterns, complications, and predictors for conservative/surgical management in patients with lateral condyle humeral fractures between 0 and 18 years of age. METHODS: This was a single-center retrospective study conducted between January 2006 and December 2016. RESULTS: There were 268 patients identified with lateral condyle elbow fracture. Majority of the patients (81.4%) with lateral condyle humeral fractures presented with either undisplaced or minimally displaced (<2 mm) fractures. The initial management in majority (90.7%) of the patients was conservative. Of the patients, 26.8% had secondary displacement at follow-up. The overall proportion of patients who required surgical intervention was 36.2%. Varus deformity of elbow (2.2%) and malunion (0.4%) were the complications noticed on long-term follow-up. Increased age and undisplaced fracture were statistically significant positive predictors for conservative management. The presence of concurrent elbow injuries and type of fracture (displaced >2 mm) were statistically significant positive predictors for surgical management. CONCLUSIONS: Our study demonstrated that majority of the patients with lateral condyle humeral fractures had presented with either undisplaced or minimally displaced (<2 mm) fractures. The positive predictors for conservative management of fractures were increased age and undisplaced fracture. The positive predictors for surgical management of lateral condyle humerus fractures were concurrent injuries in elbow and type of fracture (displaced >2 mm). Physician vigilance to the possibility of additional migration of lateral condyle fractures initially managed conservatively, and the need for subsequent surgical stabilization plays an important role in the management of these fractures.