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Published in: European Journal of Trauma and Emergency Surgery 2/2021

Open Access 01-04-2021 | Pseudarthrosis | Review Article

Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

Authors: Dirk Walther Sommerfeldt, Peter Paul Schmittenbecher

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2021

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Abstract

Purpose

Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities.

Methods

The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases.

Results

In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome.

Conclusion

In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.
Literature
1.
go back to reference Abzug JM, Dua K, Kozin SH, Herman MJ. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg. 2020;28:e9–19.CrossRef Abzug JM, Dua K, Kozin SH, Herman MJ. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg. 2020;28:e9–19.CrossRef
2.
go back to reference Barrera-Ochoa SS, Soldado F, Rodriguez-Baeza A, Diaz-Gallardo P, Hodgson F, Corona P, Knorr J. Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: an anatomical study and report of two successfully-treated pediatric cases. Microsurgery. 2019;39:156–9.CrossRef Barrera-Ochoa SS, Soldado F, Rodriguez-Baeza A, Diaz-Gallardo P, Hodgson F, Corona P, Knorr J. Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: an anatomical study and report of two successfully-treated pediatric cases. Microsurgery. 2019;39:156–9.CrossRef
3.
go back to reference Chubb PDO, Oishi S, Lattanza L. Free vascularized iliac crest bone craft for the treatment of a pediatric lateral humeral condyle fracture nonunion: a case report. JBJS Case Connect. 2012;2:e63.CrossRef Chubb PDO, Oishi S, Lattanza L. Free vascularized iliac crest bone craft for the treatment of a pediatric lateral humeral condyle fracture nonunion: a case report. JBJS Case Connect. 2012;2:e63.CrossRef
4.
go back to reference Cunningham BP, Brazina S, Morshed S, Miclau T. Fracture healing: a review of clinical, imaging and laboratory diagnostic options. Injury. 2017;48(Suppl 1):S69–75.CrossRef Cunningham BP, Brazina S, Morshed S, Miclau T. Fracture healing: a review of clinical, imaging and laboratory diagnostic options. Injury. 2017;48(Suppl 1):S69–75.CrossRef
5.
go back to reference Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988;59:419–24.CrossRef Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988;59:419–24.CrossRef
6.
go back to reference Fischer C. Diagnostik und Klassifikation von Pseudarthrosen. Unfallchirurg. 2020;123:671–8.CrossRef Fischer C. Diagnostik und Klassifikation von Pseudarthrosen. Unfallchirurg. 2020;123:671–8.CrossRef
7.
go back to reference Flynn J. Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop. 1989;9:691–6.CrossRef Flynn J. Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop. 1989;9:691–6.CrossRef
9.
go back to reference Greenhill DA, Funk S, Elliott M, Jo C-H, Ramo BA. Minimally displaced humeral lateral condyle fractures: immobilize or operate when stability is unclear? J Pediatr Orthop. 2019;39:e349–54.CrossRef Greenhill DA, Funk S, Elliott M, Jo C-H, Ramo BA. Minimally displaced humeral lateral condyle fractures: immobilize or operate when stability is unclear? J Pediatr Orthop. 2019;39:e349–54.CrossRef
10.
go back to reference Gubin AV, Borzunov DY, Marchenkova LO, Malkova TA, Smirnova IL. Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr. 2016;11:145–52.CrossRef Gubin AV, Borzunov DY, Marchenkova LO, Malkova TA, Smirnova IL. Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr. 2016;11:145–52.CrossRef
11.
go back to reference Holt JB, Glass NA, Shah AS. Understanding the epidemiology of pediatric supracondylar humeral fractures in the united states: identifying opportunities for intervention. J Pediatr Orthop. 2018;38:e245–51.CrossRef Holt JB, Glass NA, Shah AS. Understanding the epidemiology of pediatric supracondylar humeral fractures in the united states: identifying opportunities for intervention. J Pediatr Orthop. 2018;38:e245–51.CrossRef
12.
go back to reference Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6:312–5.CrossRef Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6:312–5.CrossRef
13.
go back to reference Kimball JP, Glowczewskie F, Wright TW. Intraosseous blood supply to the distal humerus. Elbow. 2007;32:642–6. Kimball JP, Glowczewskie F, Wright TW. Intraosseous blood supply to the distal humerus. Elbow. 2007;32:642–6.
14.
go back to reference Knapik DM, Gilmore A, Liu RW. Conservative management of minimally displaced (<2mm) fractures of the lateral humeral condyle in pediatric patients: a systematic review. J Pediatr Orthop. 2017;37:e83–7.CrossRef Knapik DM, Gilmore A, Liu RW. Conservative management of minimally displaced (<2mm) fractures of the lateral humeral condyle in pediatric patients: a systematic review. J Pediatr Orthop. 2017;37:e83–7.CrossRef
15.
go back to reference Knight DM, Alves C, Alman B, Howar A. Percutaneous screw fixation promotes healing of lateral condyle nonunion in children. J Pediatr Orthop. 2014;34:155–60.CrossRef Knight DM, Alves C, Alman B, Howar A. Percutaneous screw fixation promotes healing of lateral condyle nonunion in children. J Pediatr Orthop. 2014;34:155–60.CrossRef
16.
go back to reference Kocak T, Gebhard F, Keppler P. Pseudarthrose des kindlichen Condylus radialis humeri mit posttraumatischem Cubitus valgus. Unfallchirurg. 2010;113:1–6.CrossRef Kocak T, Gebhard F, Keppler P. Pseudarthrose des kindlichen Condylus radialis humeri mit posttraumatischem Cubitus valgus. Unfallchirurg. 2010;113:1–6.CrossRef
17.
go back to reference Laer L, Brunner R, Lampert C. Fehlverheilte suprakondyläre und kondyläre Humerusfrakturen. Orthopäde. 1991;20:331–40. Laer L, Brunner R, Lampert C. Fehlverheilte suprakondyläre und kondyläre Humerusfrakturen. Orthopäde. 1991;20:331–40.
18.
go back to reference Laer LV, Schneidmüller D, Hell A-K (2020) Frakturen und Luxationen im Wachstumsalter. Posttraumatische Deformitäten und deren Korrektur. 21.3 Distaler Humerus – artikulär. Thieme, Stuttgart, pp 246–250 Laer LV, Schneidmüller D, Hell A-K (2020) Frakturen und Luxationen im Wachstumsalter. Posttraumatische Deformitäten und deren Korrektur. 21.3 Distaler Humerus – artikulär. Thieme, Stuttgart, pp 246–250
19.
go back to reference Launay F, Leet AI, Jacopin S, Jouve J-L, Bollini G, Sponseller PD. Lateral humeral condyle fractures in children. J Pediatr Orthop. 2004;24:385–91.CrossRef Launay F, Leet AI, Jacopin S, Jouve J-L, Bollini G, Sponseller PD. Lateral humeral condyle fractures in children. J Pediatr Orthop. 2004;24:385–91.CrossRef
20.
go back to reference Lexer E. Über freie Transplantationen. Langenbecks Arch klin Chir. 1911;95:827. Lexer E. Über freie Transplantationen. Langenbecks Arch klin Chir. 1911;95:827.
21.
go back to reference Mills LA, Simpson AH. The risk of non-union per fracture in children. J Child Orthop. 2013;7:317–22.CrossRef Mills LA, Simpson AH. The risk of non-union per fracture in children. J Child Orthop. 2013;7:317–22.CrossRef
22.
go back to reference Morgan SJ, Beaver WB. Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up. J Orthop Trauma. 1999;13:456–8.CrossRef Morgan SJ, Beaver WB. Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up. J Orthop Trauma. 1999;13:456–8.CrossRef
23.
go back to reference Müller LP, Hansen M, Morrey BF, Prommersberger KJ, Rommens PM. The surgery of neglected distal humerus fractures in children and adults. In: Celli A, Celli L, Morrey BF, editors. Treatment of elbow lesions. Milan: Springer Verlag; 2008. p. 221–30.CrossRef Müller LP, Hansen M, Morrey BF, Prommersberger KJ, Rommens PM. The surgery of neglected distal humerus fractures in children and adults. In: Celli A, Celli L, Morrey BF, editors. Treatment of elbow lesions. Milan: Springer Verlag; 2008. p. 221–30.CrossRef
25.
go back to reference Pace JL, Arkader A, Sousa T, Broom A, Shabtai L. Incidence, risk factors and definition for nonunion in pediatric lateral condyle fractures. J Pediatr Orthop. 2018;38:e257–61.CrossRef Pace JL, Arkader A, Sousa T, Broom A, Shabtai L. Incidence, risk factors and definition for nonunion in pediatric lateral condyle fractures. J Pediatr Orthop. 2018;38:e257–61.CrossRef
26.
go back to reference Park H, Hwang JH, Kwon YU, Kim HW. Osteosynthesis in situ for lateral condyle nonunion in children. J Pediatr Orthop. 2015;35:334–40.CrossRef Park H, Hwang JH, Kwon YU, Kim HW. Osteosynthesis in situ for lateral condyle nonunion in children. J Pediatr Orthop. 2015;35:334–40.CrossRef
27.
go back to reference Pirker ME, Weinberg AM, Höllwarth ME, Haberlik A. Subsequent displacement of initially nondisplaced and minimally displaced fractures of the lateral humeral condyle in children. J Trauma. 2005;58:1202–7.CrossRef Pirker ME, Weinberg AM, Höllwarth ME, Haberlik A. Subsequent displacement of initially nondisplaced and minimally displaced fractures of the lateral humeral condyle in children. J Trauma. 2005;58:1202–7.CrossRef
28.
go back to reference Ramo BA, Funk SS, Elliott ME, Jo C-H. The Song classification is reliable and guides prognosis and treatment for pediatric lateral condyle fractures: an independent validation study with treatment algorithm. J Pediatr Orthop. 2020;40:e203–9.CrossRef Ramo BA, Funk SS, Elliott ME, Jo C-H. The Song classification is reliable and guides prognosis and treatment for pediatric lateral condyle fractures: an independent validation study with treatment algorithm. J Pediatr Orthop. 2020;40:e203–9.CrossRef
29.
go back to reference Salgueiro L, Roocroft JH, Bastrom TP, Edmonds EW, Pennock AT, Upasani VV, Yaszay B. Rate and risk factors for delayed healing following surgical treatment of lateral condyle humerus fractures in children. J Pediatr Orthop. 2017;37:1–6.CrossRef Salgueiro L, Roocroft JH, Bastrom TP, Edmonds EW, Pennock AT, Upasani VV, Yaszay B. Rate and risk factors for delayed healing following surgical treatment of lateral condyle humerus fractures in children. J Pediatr Orthop. 2017;37:1–6.CrossRef
30.
go back to reference Shrader WM, Stans AA, Shaughnessy WJ, Haidukewych GJ. Nonunion of fractures in pediatric patients: 15-year experience at a level I trauma center. Orthopedics. 2009;32:410–4.CrossRef Shrader WM, Stans AA, Shaughnessy WJ, Haidukewych GJ. Nonunion of fractures in pediatric patients: 15-year experience at a level I trauma center. Orthopedics. 2009;32:410–4.CrossRef
31.
go back to reference Slongo T, Schmid K, Wilkins K, Joeris A. Lateral external fixator – a new surgical technique for displaced unreducible supracondylar humerus fractures in children. J Bone Jt Surg Am. 2008;90:1690–7.CrossRef Slongo T, Schmid K, Wilkins K, Joeris A. Lateral external fixator – a new surgical technique for displaced unreducible supracondylar humerus fractures in children. J Bone Jt Surg Am. 2008;90:1690–7.CrossRef
32.
go back to reference Song KS, Kang CH, Min BW, Bae KC, Cho CH, Lee JH. Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. J Bone Jt Surg Am. 2008;90:2673–81.CrossRef Song KS, Kang CH, Min BW, Bae KC, Cho CH, Lee JH. Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. J Bone Jt Surg Am. 2008;90:2673–81.CrossRef
33.
go back to reference Tien Y-C, Chen J-C, Fu Y-C, Chih T-T, Huang P-J, Wang G-J. Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children: surgical technique. J Bone Jt Surg Am. 2006;88(Suppl 1):191–201.CrossRef Tien Y-C, Chen J-C, Fu Y-C, Chih T-T, Huang P-J, Wang G-J. Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children: surgical technique. J Bone Jt Surg Am. 2006;88(Suppl 1):191–201.CrossRef
34.
go back to reference Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Narita S. Osteosynthesis for nonunion of the lateral humeral condyle. Clin Orthop Relat Res. 2002;405:230–41.CrossRef Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Narita S. Osteosynthesis for nonunion of the lateral humeral condyle. Clin Orthop Relat Res. 2002;405:230–41.CrossRef
35.
go back to reference Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Harata S. Lang-standing nonunion of fractures of the lateral humeral condyle. J Bone Jt Surg Am. 2002;84:593–8.CrossRef Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Harata S. Lang-standing nonunion of fractures of the lateral humeral condyle. J Bone Jt Surg Am. 2002;84:593–8.CrossRef
36.
go back to reference Vocke-Hell AK, Schmidt A. Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children. J Pediatr Orthop B. 2001;10:138–41.PubMed Vocke-Hell AK, Schmidt A. Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children. J Pediatr Orthop B. 2001;10:138–41.PubMed
37.
go back to reference Wegmann K, Burkhart KJ, Koslowsky TC, Koebke J, Neiss WF, Müller LP. Arterial supply of the distal humerus. Surg Radiol Anat. 2014;36:705–11.CrossRef Wegmann K, Burkhart KJ, Koslowsky TC, Koebke J, Neiss WF, Müller LP. Arterial supply of the distal humerus. Surg Radiol Anat. 2014;36:705–11.CrossRef
38.
go back to reference Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop. 2009;29:602–5.CrossRef Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop. 2009;29:602–5.CrossRef
39.
go back to reference Zura R, Kaste SC, Heffernan MJ, Accousti WK, Gargiulo D, Wang Z, Stehen G. Risk factors for nonunion of bone fracture in pediatric patients. An inception cohort study of 237 033 fractures. Medicine. 2018;97(31):e11691.CrossRef Zura R, Kaste SC, Heffernan MJ, Accousti WK, Gargiulo D, Wang Z, Stehen G. Risk factors for nonunion of bone fracture in pediatric patients. An inception cohort study of 237 033 fractures. Medicine. 2018;97(31):e11691.CrossRef
Metadata
Title
Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood
Authors
Dirk Walther Sommerfeldt
Peter Paul Schmittenbecher
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Keyword
Pseudarthrosis
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01613-3

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