Radiological comparison of parallel fixation and divergent fixation using K-wire in pediatric lateral condyle fractures

Abstract

Aim: Lateral condyle fractures (LCF) of the humerus are the second most common (10-20%) after supracondylar fractures in childhood. Many methods have been described in the literature for their treatment, but a gold standard method has not been proposed. In this study, we aimed to compare the radiological results and complications of 2 different fixation methods (parallel or divergent) with K-wire in treatment. Methods: Patients under 18 years of age who were operated in our hospital due to humeral LCF between January 2014 and January 2020 were included in this retrospective cohort study. They were divided into Group 1 (fixed with parallel K-wire) and Group 2 (fixed with divergent K-wire). The age, and gender of the patients were noted, and side, type of fracture, type of treatment, radiological union times, nonunion or delayed union, fishtail deformity, excessive growth of the lateral condyle (spur) and avascular necrosis were evaluated using plain radiographs. Results: The mean age of 41 patients included in the study were 4.69 years, there were 28 males and 13 females. The most common type of fracture was Weiss type 2 (n=23). The most common complication was lateral overgrowth (spur) (n=7). There was no significant difference between the radiological union times and the number of complications in both groups (P=0.079, P=0.56 respectively). Conclusion: Both methods used in LCF fractures yielded satisfactory results. Avascular necrosis rates are high in the treatment of type 3 fractures, in which strict follow-up is important.

Keywords

• lateral condyle
• fracture
• humerus
• lateral spur
• child

Pediatrik humerus lateral kondil kırıklarında K-teli kullanılarak yapılan paralel tespit ile divergan tespitin radyolojik karşılaştırması

Öz

Amaç: Çocukluk çağında humerusun lateral kondil kırıkları (LKK), suprakondiler kırıklardan sonra en sık (%10-20) ikinci sıradadır. Literatürde bu kırıkların tedavisi için birçok yöntem tanımlanmıştır, ancak altın standart bir yöntem önerilmemiştir. Bu çalışmada, tedavide K-teli ile 2 farklı fiksasyon yönteminin (parallel veya diverjan) radyolojik sonuçlarını ve komplikasyonlarını karşılaştırmayı amaçladık Yöntemler: Ocak 2014-Ocak 2020 tarihleri arasında hastanemize humerus LKK nedeniyle başvuran ve 18 yaş altı olan çocuk hastalar bu retrospektif kohort çalışmaya dahil edildi. Çalışmaya dahil edilen hastalarımızın tamamı LKK nedeniyle ameliyat edilen 18 yaş altı çocuklardan oluştu. Hastalar Grup 1; paralel K-teli ile sabitlenmiş ve Grup 2; diverjan K-teli ile sabitlendi. Her iki grupta yaş, cinsiyet, taraf, kırık tipi, tedavi tipi, radyolojik kaynama süreleri, kaynamama veya gecikmiş kaynama, fishtail deformitesi, lateral kondilde aşırı büyüme ve avasküler nekroz olan hastalar direk radyografiler kullanılarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 41 hastanın yaş ortalaması 4,69 yıl, 28'i erkek, 13'ü kadındı. En sık görülen kırık tipi Weiss tip 2 idi (23 hasta). En sık görülen komplikasyon 7 hastada lateral aşırı büyümeydi. Her iki grupta da radyolojik kaynama süreleri ile komplikasyon sayısı arasında istatistiksel olarak anlamlı bir fark yoktu (sırasıyla P=0,079, P=0,56). Sonuç: LKK kırıklarında uygulanan 2 farklı yöntemin her ikisi de tatmin edicidir. Tip 3 kırıkların tedavisinde avasküler nekroz oranları yüksektir ve bu kırıklar da sıkı takip önemlidir.

Anahtar Kelimeler

• Lateral kondil
• Kırık
• Humerus
• Lateral spur
• Çocuk

Kaynakça

1. 1. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br. 1975 Nov;57(4):430-6. PMID: 1104630.
2. 2. Marcheix PS, Vacquerie V, Longis B, Peyrou P, Fourcade L, Moulies D. Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option? Orthop Traumatol Surg Res. 2011 May;97(3):304-7. doi: 10.1016/j.otsr.2010.10.007. Epub 2011 Apr 7. PMID: 21478066.
3. 3. Loke WP, Shukur MH, Yeap JK. Screw osteosynthesis of displaced lateral humeral condyle fractures in children: a mid-term review. Med J Malaysia. 2006 Feb;61Suppl A:40-4. PMID: 17042228.
4. 4. Li WC, Xu RJ. Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Int Orthop. 2012 Jun;36(6):1261-6. doi: 10.1007/s00264-011-1452-y. Epub 2011 Dec 17. PMID: 22179811; PMCID: PMC3353087.
5. 5. Mirsky EC, Karas EH, Weiner LS. Lateral condyle fractures in children: evaluation of classification and treatment. J Orthop Trauma. 1997 Feb-Mar;11(2):117-20. doi: 10.1097/00005131-199702000-00009. PMID: 9057147.
6. 6. Bhandari M, Tornetta P, Swiontkowksi MF; Evidence-Based Orthopaedic Trauma Working Group. Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma. 2003 Apr;17(4):306-8. doi: 10.1097/00005131-200304000-00012. PMID: 12679694.
7. 7. 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 Joint Surg Am. 2008 Dec;90(12):2673-81. doi: 10.2106/JBJS.G.01227. PMID: 19047713.
8. 8. 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 Sep;29(6):602-5. doi: 10.1097/BPO.0b013e3181b2842c. PMID: 19700990.

9. 9. Thomas DP, Howard AW, Cole WG, Hedden DM. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop. 2001 Sep-Oct;21(5):565-9. PMID: 11521019.
10. 10. Wattenbarger JM, Gerardi J, Johnston CE. Late open reduction internal fixation of lateral condyle fractures. J Pediatr Orthop. 2002 May-Jun;22(3):394-8. PMID: 11961463.
11. 11. Bast SC, Hoffer MM, Aval S. Nonoperative treatment for minimally and nondisplaced lateral humeral condyle fractures in children. J Pediatr Orthop. 1998 Jul-Aug;18(4):448-50. PMID: 9661850.
12. 12. Kamegaya M, Shinohara Y, Kurokawa M, Ogata S. Assessment of stability in children's minimally displaced lateral humeral condyle fracture by magnetic resonance imaging. J Pediatr Orthop. 1999 Sep-Oct;19(5):570-2. PMID: 10488852.
13. 13. 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 Jan 1;28(1):e9-e19. doi: 10.5435/JAAOS-D-17-00815. PMID: 31268870
14. 14. 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 Jun;58(6):1202-7. doi: 10.1097/01.ta.0000169869.08723.c8. PMID: 15995471.
15. 15. Canale ST. Fractures And Dislocations In Children. In: Canale ST, Beaty JH editors. Campell’s operative orthopeadics, Mosby Elsevier, 2008: 1531-1725.
16. 16. Beaty JH, Kasser JR. The elbow: Physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea and condylar fractures. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkin’s Fractures in Children. Philadelphia: Lippincott Williams &Wilkins; 2006:591–660.
17. 17. Koh KH, Seo SW, Kim KM, Shim JS. Clinical and radiographic results of lateral condylar fracture of distal humerus in children. J Pediatr Orthop. 2010 Jul-Aug;30(5):425-9. doi: 10.1097/BPO.0b013e3181df1578. PMID: 20574257.
18. 18. Pribaz JR, Bernthal NM, Wong TC, Silva M. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop. 2012 Jul-Aug;32(5):456-60. doi: 10.1097/BPO.0b013e318259ff63. PMID: 22706459.
19. 19. Shaerf DA, Vanhegan IS, Dattani R. Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder Elbow. 2018 Apr;10(2):114-120. doi: 10.1177/1758573217701107. Epub 2017 Apr 11. PMID: 29560037; PMCID: PMC5851120.
20. 20. Roye DP Jr, Bini SA, Infosino A. Late surgical treatment of lateral condylar fractures in children. J Pediatr Orthop. 1991 Mar-Apr;11(2):195-9. doi: 10.1097/01241398-199103000-00011. PMID: 2010520.
21. 21. Gaur SC, Varma AN, Swarup A. A new surgical technique for old ununited lateral condyle fractures of the humerus in children. J Trauma. 1993 Jan;34(1):68-9. doi: 10.1097/00005373-199301000-00012. PMID: 8437198.
22. 22. Shimada K, Masada K, Tada K, Yamamoto T. Osteosynthesis for the treatment of non-union of the lateral humeral condyle in children. J Bone Joint Surg Am. 1997 Feb;79(2):234-40. doi: 10.2106/00004623-199702000-00011. PMID: 9052545.
23. 23. Pace JL, Arkader A, Sousa T, Broom AM, Shabtai L. Incidence, Risk Factors, and Definition for Nonunion in Pediatric Lateral Condyle Fractures. J Pediatr Orthop. 2018 May/Jun;38(5):e257-e261. doi: 10.1097/BPO.0000000000001153. PMID: 29635260.
24. 24. Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am. 2008 Apr;39(2):163-71, v. doi: 10.1016/j.ocl.2007.12.005. PMID: 18374807.
25. 25. van Vugt AB, Severijnen RV, Festen C. Fractures of the lateral humeral condyle in children: late results. Arch Orthop Trauma Surg. 1988;107(4):206-9. doi: 10.1007/BF00449669. PMID: 3408313.
26. 26. Bloom T, Chen LY, Sabharwal S. Biomechanical analysis of lateral humeral condyle fracture pinning. J Pediatr Orthop. 2011 Mar;31(2):130-7. doi: 10.1097/BPO.0b013e3182074c5b. PMID: 21307705.
27. 27. Blasier RD. Operative treatment of lateral condyle fractures. In: Tolo VT, Skaggs DL, eds. Master Techniques in Orthopaedic Surgery Pediatrics. Philadelphia, PA: Lippincott Williams & Wilkens; 2008:2.