TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUQi , CHENMang ,  ZHOUMin , LIAOChunlai , CAIJundong

1. Department of Trauma Orthopedics, the 188th Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China;
2. Department of Bone and Joint Surgery, the 188th Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China;

Corresponding author：

ZHOUMin, Email: 1192396762@qq.com

Keywords：

Lateral humeral condyle fracture; Bone nonunion; Cubitus valgus deformity

DOI：

10.7507/1002-1892.20140092

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Objective To investigate the surgical procedures and results of nonunion of lateral humeral condyle fracture combined with cubitus valgus. Methods Between January 2006 and September 2011, 19 cases of nonunion of lateral humeral condyle fracture combined with cubitus valgus were treated with supracondylar closing wedge osteotomy, open reduction, autogenous bone grafting, and internal fixation. There were 11 males and 8 females, aged 14-28 years (mean, 21.6 years). The left side was involved in 7 cases, and the right side in 12 cases. The disease duration was 3-22 years (mean, 9 years). The osseous protuberance and enlargement were seen in the lateral condyle of all the cases, with cubitus valgus. Compared with the contralateral side, the angle of cubitus valgus deformity increased (34.00±7.68)° at the affected side. The elbow range of motion of flexion and extension was (117.35±19.77)° in the other 17 patients except 2 patients with joint stiff. Among them, 10 patients had limited mobility. Three patients had ulnar neuritis. Results All the patients obtained primary healing of incision, and no surgery-related complication occurred. Nineteen patients were followed up 2-6 years (mean, 3.2 years). Bony union at lateral condylar fracture site and the supracondylar osteotomy site was achieved in all cases within 6 months postoperatively. In 3 patients with ulnar neuritis, the symptoms of nerve injury disappeared within 6 months. At last follow-up, the angle of cubitus valgus deformity increased (3.21±4.09)° at the affected side when compared with the contralateral side, showing significant difference when compared with preoperative angle (t=30.472, P=0.000). The range of motion of the elbow was 20° and 30° in 2 patients with joint stiff before operation; the elbow range of motion of flexion and extension was (117.64±15.72)° in the other 17 patients, showing no significant difference when compared with preoperative value (t=-0.180, P=0.859). According to the appearance of the elbow, range of motion, and complications, the overall results were classified as excellent in 9 patients, good in 8 patients, and poor in 2 patients; the excellent and good rate was 89.5%. Conclusion Supracondylar closing wedge osteotomy can correct the cubitus valgus deformity and improve the symptoms of ulnar neuritis. Open reduction, autogenous bone grafting, and internal fixation for nonunion of the lateral condyle can effectively stabilize the lateral condylar fracture and promote fracture healing.

Citation： SUQi, CHENMang, ZHOUMin, LIAOChunlai, CAIJundong. TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 406-409. doi: 10.7507/1002-1892.20140092 Copy

1.	Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6):350-358.
2.	袁华军, 梁善荣. 儿童肱骨外髁骨折不愈合并肘外翻的手术治疗. 中华小儿外科杂志, 2000, 21(6):374.
3.	罗汉文, 陈志维, 熊昌盛, 等. 肱骨外髁重建术治疗肱骨外髁骨折骨不连并肘外翻畸形的远期随访. 中国骨伤, 2006, 19(5):302.
4.	Meyer NJ, Lyon RM. Lateral elbow ecchymosis as a clinical sign of lateral humeral condylar fractures. Am J Orthop (Belle Mead NJ), 2003, 32(5):260-261.
5.	Song KS, Kang CH, Min BW, et al. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2007, 89(1):58-63.
6.	覃佳强, 封林, 李明, 等. 儿童肱骨外髁骨折后遗畸形的手术及康复治疗. 中国矫形外科杂志, 2007, 15(18):1379-1381, 1399.
7.	Marcheix PS, Vacquerie V, Longis B, et al. Distal humerus lateral condyle fracture in children:when is the conservative treatment a valid option? Orthop Traumatol Surg Res, 2011, 97(3):304-307.
8.	Jenyo M, Mirdad T. Fracture of the lateral condyle ofthe humeras in children. East Afr Med J, 2001, 78(8):424-429.
9.	Agarwal A, Qureshi NA, Gupta N, et al. Management of neglected lateral condyle fractures of humerus in children:A retrospective study. Indian J Orthop, 2012, 46(6):698-704.
10.	张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 2012, 20(18):1633-1637.
11.	阿斯哈尔江·买买提依明, 阿德力·阿布都热西提, 艾克拜尔·尤努斯. 髁上截骨和外侧柱重建术治疗肱骨外髁骨折不连伴肘外翻畸形. 中国修复重建外科杂志, 2009, 23(4):423-425.
12.	熊昌盛, 陈志维, 李逸群, 等. 肱骨远端外柱重建治疗的手术疗效观察. 中国矫形外科杂志, 2010, 18(10):859-861.
13.	封林, 覃佳强, 张德文, 等. 儿童肱骨外髁骨折后骨不连的治疗. 中华创伤杂志, 2006, 22(11):869-870.
14.	杨源中, 谢强, 刘艺祥, 等. 肘外翻畸形的手术治疗(附12例报告). 中国骨与关节损伤杂志, 2005, 20(4):263-264.
15.	刘刚, 钟刚, 易敏, 等. 肘外翻畸形导致肘管综合征的相关因素分析. 中国修复重建外科杂志, 2010, 24(8):967-971.
16.	沈品泉, 张菁, 陈珽. 儿童陈旧性肱骨外髁骨折的治疗. 中国修复重建外科杂志, 2007, 21(3):266-268.
17.	张作君, 牛素玲, 朱文潇. 肱骨外髁骨折不愈合伴发育不全的手术治疗. 中国骨与关节损伤杂志, 2009, 24(1):47-49.
18.	牛云飞, 张春才, 禹宝庆, 等. 重建髁部治疗肱骨髁上髁间严重骨缺损性骨不连. 中国修复重建外科杂志, 2008, 22(1):36-39.

1. Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6):350-358.
2. 袁华军, 梁善荣. 儿童肱骨外髁骨折不愈合并肘外翻的手术治疗. 中华小儿外科杂志, 2000, 21(6):374.
3. 罗汉文, 陈志维, 熊昌盛, 等. 肱骨外髁重建术治疗肱骨外髁骨折骨不连并肘外翻畸形的远期随访. 中国骨伤, 2006, 19(5):302.
4. Meyer NJ, Lyon RM. Lateral elbow ecchymosis as a clinical sign of lateral humeral condylar fractures. Am J Orthop (Belle Mead NJ), 2003, 32(5):260-261.
5. Song KS, Kang CH, Min BW, et al. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2007, 89(1):58-63.
6. 覃佳强, 封林, 李明, 等. 儿童肱骨外髁骨折后遗畸形的手术及康复治疗. 中国矫形外科杂志, 2007, 15(18):1379-1381, 1399.
7. Marcheix PS, Vacquerie V, Longis B, et al. Distal humerus lateral condyle fracture in children:when is the conservative treatment a valid option? Orthop Traumatol Surg Res, 2011, 97(3):304-307.
8. Jenyo M, Mirdad T. Fracture of the lateral condyle ofthe humeras in children. East Afr Med J, 2001, 78(8):424-429.
9. Agarwal A, Qureshi NA, Gupta N, et al. Management of neglected lateral condyle fractures of humerus in children:A retrospective study. Indian J Orthop, 2012, 46(6):698-704.
10. 张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 2012, 20(18):1633-1637.
11. 阿斯哈尔江·买买提依明, 阿德力·阿布都热西提, 艾克拜尔·尤努斯. 髁上截骨和外侧柱重建术治疗肱骨外髁骨折不连伴肘外翻畸形. 中国修复重建外科杂志, 2009, 23(4):423-425.
12. 熊昌盛, 陈志维, 李逸群, 等. 肱骨远端外柱重建治疗的手术疗效观察. 中国矫形外科杂志, 2010, 18(10):859-861.
13. 封林, 覃佳强, 张德文, 等. 儿童肱骨外髁骨折后骨不连的治疗. 中华创伤杂志, 2006, 22(11):869-870.
14. 杨源中, 谢强, 刘艺祥, 等. 肘外翻畸形的手术治疗(附12例报告). 中国骨与关节损伤杂志, 2005, 20(4):263-264.
15. 刘刚, 钟刚, 易敏, 等. 肘外翻畸形导致肘管综合征的相关因素分析. 中国修复重建外科杂志, 2010, 24(8):967-971.
16. 沈品泉, 张菁, 陈珽. 儿童陈旧性肱骨外髁骨折的治疗. 中国修复重建外科杂志, 2007, 21(3):266-268.
17. 张作君, 牛素玲, 朱文潇. 肱骨外髁骨折不愈合伴发育不全的手术治疗. 中国骨与关节损伤杂志, 2009, 24(1):47-49.
18. 牛云飞, 张春才, 禹宝庆, 等. 重建髁部治疗肱骨髁上髁间严重骨缺损性骨不连. 中国修复重建外科杂志, 2008, 22(1):36-39.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS

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