Comparison of effectiveness between two surgical methods for humeral lateral condyle fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Hailong , WU Qingjie , LIU Fang , HUA Zhongtuo ,  ZHANG Sicheng

Department of Orthopedics, Anhui Provincial Children’s Hospital, Anhui Medical University Children’s Medical Center, Hefei Anhui, 230051, P. R. China;

Corresponding author：

ZHANG Sicheng, Email: zsc_zls@126.com

Keywords：

Ultrasound; humeral lateral condyle fracture; closed reduction; internal fixation; child

DOI：

10.7507/1002-1892.202410046

Video：

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Objective To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. Methods A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation (P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. Results In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group (P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant (P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time (P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant (P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups (P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. Conclusion The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.

1.	Sojib MFMI, Wang YS. Comparative analysis of surgical outcomes in children with type 3 and type 4 lateral physeal condylar humerus fractures in china: closed reduction-percutaneous pinning (CRPP) vs. open reduction-internal fixation (ORIF). J Orthop, 2024, 54: 22-31.
2.	刘朝宇, 贾国强, 黄秀明, 等. 超声引导闭合复位克氏针固定治疗不同类型儿童不稳定型肱骨外髁骨折疗效比较. 中国修复重建外科杂志, 2024, 38(3): 278-283.
3.	Tippabhatla A, Torres-Izquierdo B, Pereira DE, et al. Closed reduction techniques are associated with fewer complications than open reductions in treating moderately displaced pediatric lateral humeral condyle fractures: a multicenter study. J Pediatr Orthop, 2024, 44(10): e865-e870.
4.	Rehm A, Newton AC, Hatzantoni K, et al. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury, 2024, 55(6): 111575. doi: 10.1016/j.injury.2024.111575.
5.	Abzug JM, Dua K, Kozin SH, et al. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg, 2020, 28(1): e9-e19.
6.	Jakob R, Fowles JV, Rang M, et al. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg (Br), 1975, 57(4): 430-436.
7.	Nazareth A, VandenBerg CD, Sarkisova N, et al. Prospective evaluation of a treatment protocol based on fracture displacement for pediatric lateral condyle humerus fractures: a preliminary study. J Pediatr Orthop, 2020, 40(7): e541-e546.
8.	马海龙, 孙锡玮, 刘方, 等. 经皮克氏针固定与弹性髓内钉内固定治疗儿童桡骨颈骨折的疗效比较. 中华创伤骨科杂志, 2024, 26(8): 691-697.
9.	马海龙, 李阳, 袁悦, 等. 超声联合关节造影辅助治疗儿童桡骨远端Salter-Harris Ⅲ型骨骺骨折的中短期疗效. 中华小儿外科杂志, 2024, 45(2): 138-142.
10.	马海龙, 周志林, 张思成, 等. 超声引导克氏针挑拨技术治疗儿童青少年Salter-HarrisⅠ、Ⅱ型骨膜卡压胫骨远端骨骺骨折短期疗效. 中国修复重建外科杂志, 2023, 37(12): 1477-1481.
11.	刘大山, 孙一田, 段晓堃, 等. 儿童Jacob Ⅲ型肱骨外髁骨折经皮与开放克氏针固定比较. 中国矫形外科杂志, 2024, 32(18): 1663-1668.
12.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
13.	Xie LW, Tan G, Deng ZQ, et al. Impacts of fracture types on success rate of closed reduction and percutaneous pinning in pediatric lateral condyle humerus fractures displaced >4 mm. J Pediatr Orthop, 2022, 42(5): 265-272.
14.	Rehm A, Ong JCY, Ashby E. Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children. J Orthop Surg Res, 2022, 17(1): 10. doi: 10.1186/s13018-021-02894-5.
15.	Li XT, Shen XT, Wu X, et al. A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res, 2019, 105(3): 557-562.
16.	Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
17.	Liu Y, Shi W, Zhao H, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. Int Orthop, 2022, 46(10): 2291-2297.
18.	Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.

1. Sojib MFMI, Wang YS. Comparative analysis of surgical outcomes in children with type 3 and type 4 lateral physeal condylar humerus fractures in china: closed reduction-percutaneous pinning (CRPP) vs. open reduction-internal fixation (ORIF). J Orthop, 2024, 54: 22-31.
2. 刘朝宇, 贾国强, 黄秀明, 等. 超声引导闭合复位克氏针固定治疗不同类型儿童不稳定型肱骨外髁骨折疗效比较. 中国修复重建外科杂志, 2024, 38(3): 278-283.
3. Tippabhatla A, Torres-Izquierdo B, Pereira DE, et al. Closed reduction techniques are associated with fewer complications than open reductions in treating moderately displaced pediatric lateral humeral condyle fractures: a multicenter study. J Pediatr Orthop, 2024, 44(10): e865-e870.
4. Rehm A, Newton AC, Hatzantoni K, et al. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury, 2024, 55(6): 111575. doi: 10.1016/j.injury.2024.111575.
5. Abzug JM, Dua K, Kozin SH, et al. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg, 2020, 28(1): e9-e19.
6. Jakob R, Fowles JV, Rang M, et al. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg (Br), 1975, 57(4): 430-436.
7. Nazareth A, VandenBerg CD, Sarkisova N, et al. Prospective evaluation of a treatment protocol based on fracture displacement for pediatric lateral condyle humerus fractures: a preliminary study. J Pediatr Orthop, 2020, 40(7): e541-e546.
8. 马海龙, 孙锡玮, 刘方, 等. 经皮克氏针固定与弹性髓内钉内固定治疗儿童桡骨颈骨折的疗效比较. 中华创伤骨科杂志, 2024, 26(8): 691-697.
9. 马海龙, 李阳, 袁悦, 等. 超声联合关节造影辅助治疗儿童桡骨远端Salter-Harris Ⅲ型骨骺骨折的中短期疗效. 中华小儿外科杂志, 2024, 45(2): 138-142.
10. 马海龙, 周志林, 张思成, 等. 超声引导克氏针挑拨技术治疗儿童青少年Salter-HarrisⅠ、Ⅱ型骨膜卡压胫骨远端骨骺骨折短期疗效. 中国修复重建外科杂志, 2023, 37(12): 1477-1481.
11. 刘大山, 孙一田, 段晓堃, 等. 儿童Jacob Ⅲ型肱骨外髁骨折经皮与开放克氏针固定比较. 中国矫形外科杂志, 2024, 32(18): 1663-1668.
12. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
13. Xie LW, Tan G, Deng ZQ, et al. Impacts of fracture types on success rate of closed reduction and percutaneous pinning in pediatric lateral condyle humerus fractures displaced >4 mm. J Pediatr Orthop, 2022, 42(5): 265-272.
14. Rehm A, Ong JCY, Ashby E. Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children. J Orthop Surg Res, 2022, 17(1): 10. doi: 10.1186/s13018-021-02894-5.
15. Li XT, Shen XT, Wu X, et al. A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res, 2019, 105(3): 557-562.
16. Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
17. Liu Y, Shi W, Zhao H, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. Int Orthop, 2022, 46(10): 2291-2297.
18. Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.

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