Abstract
Purpose
To evaluate surgical treatment of symptomatic non-union of lateral condylar elbow fractures in adults.
Methods
In this retrospective cohort study, 11 consecutive adult patients were surgically treated for symptomatic non-union of the lateral humeral condyle. Milch type I fracture non-unions (n = 3) were treated with medial closing wedge osteotomy and ulnar nerve transposition, while type II equivalents (n = 8) were treated with non-union fixation and bone grafting. Age at injury, age at referral, pre-operative symptoms, and pre-operative functional data (Modified An and Morrey functional rating index) were collected.
Results
Eleven patients (average age 20 years old) with varying symptoms attributable to non-union were surgically treated at a mean of 15.8 years following the initial fracture. Post-operative complications included one superficial infection and 17one radial nerve temporary neuropraxia. Pain, ulnar neuritis, and functional outcomes (Modified An and Morrey, mean 7.1 point improvement) improved significantly. However, the combined range of motion decreased by a mean of 11.4°.
Conclusion
Our treatment algorithm for adults with chronic neglected and symptomatic non-union of the lateral humeral condyle improved functional outcomes in this cohort.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Peterson CA, Peterson HA (1972) Analysis of the incidence of injuries to the epiphyseal growth plate. J Trauma 12:273–279
Landin LA, Danielsson LG (1986) Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 57:309–312
Milch H (1964) Fractures and fracture dislocations of the humeral condyles. J Trauma 4:592–607
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
Editorial (1985) Fractures of the lateral condyle of the humerus in children. Injury 16:363
Zeir FG (1981) Lateral condylar fracture and its many complications. Orthop Rev 10:49–55
Conner A, Smith MGH (1970) Displaced fracture of the lateral humeral condyle in children. J Bone Joint Surg Am 52:460–464
Wilkins KE, Beaty JH, Chambers HG, Toniolo RM (1996) Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, Beaty JH (eds) Fractures in children, 4th edn, vol 3. Lippincott-Raven, Philadelphia, pp 653–904
Flynn JC (1989) Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop 9:691–696
Flynn JC, Richards JF Jr, Saltzman RI (1975) Prevention and treatment of nonunion of slightly displaced fractures of the lateral humeral condyle in children: an end-result study. J Bone Joint Surg Am 57:1087–1092
Hardacre JA, Nahigian SH, Froimson AI, Brown JE (1971) Fractures of the lateral condyle of the humerus in children. J Bone Joint Surg Am 53:1083–1095
Haraldsson S (1959) Vascularization of the distal end of the humerus. Acta Orthop Scand 38:1
Kim HT, Lee JS, Yoo CI (2005) Management of cubitus varus and valgus. J Bone Joint Surg Am 87:771–780
Masada K, Kawai H, Kawabata H (1990) Osteosynthesis for old, established nonunion of the lateral condyle of the humerus. J Bone Joint Surg Am 72:32–40
Shimada K, Masada K, Tada K (1997) Osteosynthesis for the treatment of nonunion of the lateral humeral condyle in children. J Bone Joint Surg Am 79:234–240
Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Shunsuke N (2002) Osteosynthesis for nonunion of the lateral humeral condyle. Clin Orthop Relat Res 405:230–241
Wattenbarger JM, GerardiJ JCE (2002) Late open reduction internal fixation of lateral condyle fractures. J Pediatr Orthop 22:394–398
Shibata M, Yoshizu T, Tajima T (1992) Long-term results of osteosynthesis for established non-union of lateral humeral condyle in children. Orthop Surg Trauma 35:1165–1172
Eamsobhana P, Kaewpornsawan K (2015) Should we repair nonunion of the lateral humeral condyle in children? Int Orthop 39:1579–1585
Roye DP Jr, Bini SA, Infosino A (1991) Late surgical treatment of lateral condylar fractures in children. J Pediatr Orthop 11:195–199
An KN, Morrey BF (1985) Biomechanics of the elbow. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 43–61
Dhillon KS, Sengupta S, Singh BJ (1988) Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand 59:419–424
Sharma H, Sibinski M, Sherlock DA (2009) Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture. Int Orthop 33:509–514
Li WC, Xu RJ (2012) Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condylar fracture in children. Int Orthop 36:1261–1266
Acknowledgments
We would like to acknowledge the work of all our staff, especially our mentor Pro. Xieyuan Jiang.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, The IRB number is Beijing Jishuitan Hospital 201605–02. This article does not contain any studies with animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Gong, M.Q., Huang, X.W., Wang, C. et al. Management of chronic neglected lateral condyle elbow non-union in adults: functional results of a cohort study and a proposed treatment algorithm. International Orthopaedics (SICOT) 41, 157–164 (2017). https://doi.org/10.1007/s00264-016-3276-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-016-3276-2