Effectiveness comparison of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Chaoyu ¹ ,  JIA Guoqiang ² , HUANG Xiuming ³ , SHEN Xiangyang ² , YAO Jie ² , MA Hailong ²

1. Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China;
2. Anhui Medical University Children’s Medical Center, Hefei Anhui, 230051, P. R. China;
3. Department of Orthopedics, Ganzhou Maternal and Children’s Health Care Hospital, Ganzhou Jiangxi, 341000, P. R. China;

Corresponding author：

JIA Guoqiang, Email: jgqdor@126.com

Keywords：

Humeral lateralcondylar fracture; ultrasound-guided; closed reduction; children

DOI：

10.7507/1002-1892.202312018

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Objective To compare the effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children. Methods The clinical data of 94 children with unstable humeral lateralcondylar fractures admitted to three medical centers between January 2021 and October 2022 were retrospectively analyzed. The children were divided into three groups according to the Song classification and whether the elbow joint was dislocated or not, including 42 cases of Song 4 type (group A), 38 cases of Song 5 type (group B), and 14 cases of elbow joint dislocation (group C). There was no significant difference in gender, age, side, cause of injury, and time from injury to operation among the three groups (P>0.05). All children were treated with ultrasound-guided closed reduction and Kirschner wire fixation. The operation time and complications of the three groups were recorded and compared, and the failure of closed reduction was evaluated by ultrasound. X-ray examination was performed at last follow-up to measure the Baumann angle, condylar angle, carrying angle, and lateral osteophyte of the affected side; the extension, flexion, pronation, and supination range of motion of the affected elbow joint were measured; the function of the elbow joint was evaluated by Mayo score. Results The operation time in group A was significantly longer than that in groups B and C (P<0.05). There were 7, 2, and 5 cases of closed reduction failure in groups A, B, and C, respectively, and there was no significant difference in the incidence of the closed reduction failure (P>0.05). All patients were followed up 6-28 months, with an average of 15.7 months. There was no significant difference in the follow-up time among the three groups (P>0.05). Complications: in group A, there were 2 cases of delayed union, 4 cases of needle tract infection, 1 case of trochlear necrosis, and 39 cases of lateral osteophyte; in group B, there was 1 case of malunion, 5 cases of needle tract infection, 1 case of redisplacement, and 26 cases of lateral osteophyte; in group C, there were 2 cases of needle tract infection and 10 cases of lateral osteophyte. There was no significant difference in the incidence of complications among the three groups (P>0.05). No cubitus varus or cubitus valgus deformity was found in all patients. At last follow-up, except that the condylar angle in group A was significantly greater than that in groups B and C (P<0.05), there was no significant difference in other imaging indicators, elbow range of motion, or Mayo score between groups (P>0.05). Conclusion The Song type 4 of humeral lateralcondylar fracture treated with ultrasound-guided closed reduction and Kirschner wire fixation has a longer operation time, more postoperative complications, and is more prone to lateral osteophyte.

Citation： LIU Chaoyu, JIA Guoqiang, HUANG Xiuming, SHEN Xiangyang, YAO Jie, MA Hailong. Effectiveness comparison of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 278-283. doi: 10.7507/1002-1892.202312018 Copy

1.	Bhandari M, Tornetta P, Swiontkowksi MF, et al. Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma, 2003, 17(4): 306-308.
2.	Song KS, Kang CH, Min BW, et al. Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2008, 90(12): 2673-2681.
3.	Vorhies JS, Funk S, Elliott M, et al. The utility of intraoperative arthrogram in the management of pediatric lateral condyle fractures of the humerus. Orthopedics, 2020, 43(1): 30-35.
4.	李敏, 孟海亮, 苏菲, 等. 关节造影辅助治疗儿童骨折移位≤2 mm肱骨外髁骨折. 中华创伤骨科杂志, 2018, 20(9): 803-805.
5.	Xie LW, Wang J, Deng ZQ, et al. Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord, 2020, 21(1): 707.
6.	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.
7.	Xie LW, Deng ZQ, Zhao RH, et al. Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by >4 mm: an observational cross-sectional study. BMC Musculoskelet Disord, 2021, 22(1): 985.
8.	Li XT, Shen XT, Wu X, et al. Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children. J Shoulder Elbow Surg, 2021, 30(9): 2113-2119.
9.	Chaudhary S, Nongdamba H, Singh V. Impact of transverse ultrasound images on the classification and treatment of pediatric lateral humeral condyle fractures. J Pediatr Orthop, 2021, 41(2): e201-e202.
10.	Deng C, Shen Z, Wang K, et al. A novel approach for the treatment of Jacob Ⅱ and Ⅲ fractures of the lateral humeral condyle in children: Percutaneous Kirschner wire fixation with ultrasound localization. Front Surg, 2022, 9: 1000399.
11.	Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.
12.	Evans JP, Smith CD, Fine NF, et al. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg, 2018, 27(4): e98-e106.
13.	Weng L, Cao Y, Zhang G, et al. A comparative study on closed reduction vs. open reduction techniques in the surgical treatment of rotated lateral condyle fractures of the distal humerus in children. Front Pediatr, 2022, 10: 891840.
14.	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.
15.	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.
16.	Li XT, Shen XT, Wu X, et al. Impact of transverse ultrasound images on the classification and treatment of pediatric lateral humeral condyle fractures. J Pediatr Orthop, 2020, 40(4): e287-e292.
17.	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.
18.	Lan X, Dai M, Zhang B, et al. Comparative study of lateral condyle fracture with or without posteromedial elbow dislocation in children. Int Orthop, 2018, 42(3): 619-624.
19.	徐文斌, 戴蓉丹, 刘悦, 等. 超声引导下手法复位经皮交叉穿针固定治疗儿童移位型肱骨髁上骨折. 中国骨伤, 2020, 33(10): 907-911.
20.	Fuchter LM, Wills D, Walsh WR, et al. Biomechanical comparison of cortical lag screws and cortical position screws for their generation of interfragmentary compression and area of compression in simulated lateral humeral condylar fractures. Vet Comp Orthop Traumatol, 2023, 36(5): 250-256.

1. Bhandari M, Tornetta P, Swiontkowksi MF, et al. Displaced lateral condyle fractures of the distal humerus. J Orthop Trauma, 2003, 17(4): 306-308.
2. Song KS, Kang CH, Min BW, et al. Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2008, 90(12): 2673-2681.
3. Vorhies JS, Funk S, Elliott M, et al. The utility of intraoperative arthrogram in the management of pediatric lateral condyle fractures of the humerus. Orthopedics, 2020, 43(1): 30-35.
4. 李敏, 孟海亮, 苏菲, 等. 关节造影辅助治疗儿童骨折移位≤2 mm肱骨外髁骨折. 中华创伤骨科杂志, 2018, 20(9): 803-805.
5. Xie LW, Wang J, Deng ZQ, et al. Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord, 2020, 21(1): 707.
6. 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.
7. Xie LW, Deng ZQ, Zhao RH, et al. Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by >4 mm: an observational cross-sectional study. BMC Musculoskelet Disord, 2021, 22(1): 985.
8. Li XT, Shen XT, Wu X, et al. Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children. J Shoulder Elbow Surg, 2021, 30(9): 2113-2119.
9. Chaudhary S, Nongdamba H, Singh V. Impact of transverse ultrasound images on the classification and treatment of pediatric lateral humeral condyle fractures. J Pediatr Orthop, 2021, 41(2): e201-e202.
10. Deng C, Shen Z, Wang K, et al. A novel approach for the treatment of Jacob Ⅱ and Ⅲ fractures of the lateral humeral condyle in children: Percutaneous Kirschner wire fixation with ultrasound localization. Front Surg, 2022, 9: 1000399.
11. Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.
12. Evans JP, Smith CD, Fine NF, et al. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg, 2018, 27(4): e98-e106.
13. Weng L, Cao Y, Zhang G, et al. A comparative study on closed reduction vs. open reduction techniques in the surgical treatment of rotated lateral condyle fractures of the distal humerus in children. Front Pediatr, 2022, 10: 891840.
14. 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.
15. 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.
16. Li XT, Shen XT, Wu X, et al. Impact of transverse ultrasound images on the classification and treatment of pediatric lateral humeral condyle fractures. J Pediatr Orthop, 2020, 40(4): e287-e292.
17. 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.
18. Lan X, Dai M, Zhang B, et al. Comparative study of lateral condyle fracture with or without posteromedial elbow dislocation in children. Int Orthop, 2018, 42(3): 619-624.
19. 徐文斌, 戴蓉丹, 刘悦, 等. 超声引导下手法复位经皮交叉穿针固定治疗儿童移位型肱骨髁上骨折. 中国骨伤, 2020, 33(10): 907-911.
20. Fuchter LM, Wills D, Walsh WR, et al. Biomechanical comparison of cortical lag screws and cortical position screws for their generation of interfragmentary compression and area of compression in simulated lateral humeral condylar fractures. Vet Comp Orthop Traumatol, 2023, 36(5): 250-256.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children

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