Prevention And Treatment Investigation Of The Nonunion And Cubitus Valgus Deformity After Humeral Lateral Condyle Fractures In Children

Background and ObjectiveLateral condyle fractures of the humerus is one of the most frequent elbow injury, they are common in children between 2-14 years of age. Because of complex elbow anatomy and further concomitant cognitional insufficient, it is contributing to missed diagnosis and misdiagnosis. It occurs frequently with nonunion and cubitus valgus when unsuitable treatment led to elbow monstrositas, functional impairment, and long-term complications. Because children humeral lateral condyle fracture is involved in osteoepiphysis, eminentia capitata and trochlea, nonunion would result in osteoepiphysis growth inhibiting or imbalance; also elbow cacogenesis and tardy ulnar nerve palsy. Nonunion frequently accompany with cacogenesis, as these fractures is difficult to treat clinically, the management of such fractures can be technically demanding. In summary, treatment should be managed by thinking over versatility factors including improving bone healing probability, diminish injury, as far as possible to recover joint function. In few years, we have accumulated expericnce about this field, we intend further investigate etiopathogenisis, modus operandi and rehibilitation in treatment of bone nonunion and residual deformity (cubitus valgus) after humeral lateral condyle fractures in children. From the research, we want to improve the knowledge of the disease and provide appropriate treatment in different circumstance to draw back the missing function and appearance.MethodsRetrospective summarize a total of 27 patients diagnosed with humeral lateral condyle fracture follow with bone nonunion and/or cubitus valgus consecutive enrolled in Children's Hospital of chongqing Medical University from 2004 to 2006, including 19 cases of male, 8 cases of female, 16 cases of right humeral lateral condyle fracture and 11 cases of left. The mean age at injured for all the patients (n =27) was 5.6 yr (range 3–10 yr); The mean age at suigical operation for all the patients (n =27) was 9 yr (range 5–14 yr); The average time from injury to operation is 2.8 yr (range 8mon–10 yr); There are three modus operations including direct normal position internal fixation of 7 cases, open reduction following os illium bone graft internal fixation of 11 cases, distant humerus varus wedge shape cut orthopaedic for 9 cases.Results13 patients were followed up ranging from 6 month to 2 years, and 14 patients over 2 years. All the patients were achieved union for 8 to 16 weeks after surgery, excellent rerult (common elbow function and profile, flexion angle exceed 110°) were found in 13 cases(48.1%)and good (flexion angle range 90°～110°, cubitus valgus less than 10°, no pain and other residual) in 11 cases(40.8%), and poor (flexion angle less than 90°, cubitus valgus exceed 10°) in 3 cases(11.1%), the excellent and good rates was 88.9%. None of the cases happened with osteonecrosis ,traumatic arthritis and myositis ossificans.ConclusionIt is common that inadequacy knowledge, delay treatment and irrelevant treatment regimen of humeral lateral condyle fractures in children can result in bone nonunion and residual deformity (cubitus valgus) and it is difficult to treatment. Corresponding surgical treatment with different condition and early exercise can improve the appearance and function of elbow joint.