COMPLEX LATERAL HUMERAL CONDYLAR MASS FRACTURES IN CHILDREN

Abstract

Introduction: There is paucity of literature describing complex lateral condylar mass (LCM) fractures of the elbow in children, which we define as a LCM fracture occurring concurrently with another fracture or dislocation in the same elbow. The aim of this study was to evaluate the management, outcome and complication rate of 26 complex LCM fractures and to analyse difference in the outcome between the isolated and complex LCM fractures.

Materials and methods: Between 1990 and 2005, we identified 26 complex LCM fractures in the departmental database (1% of 2502 elbow/humeral injuries). Information was collected from theatre-charts, casenotes and radiographs. The mean follow-up was 5.9 months (range, 6 weeks to 4 years).

Results: These were complex because of their association with elbow dislocation (n=12; mean age 8.2 years), olecranon fracture (n=8; mean age 4.1 years) and medial condylar fracture (n=6; mean age 8 years). Nine were treated conservatively. The remaining 17 were fixed with K-wires (9), a screw (7) or both (1). A concomitant elbow dislocation was managed by closed reduction followed by open K-wiring or screw fixation of the LCM fracture. An associated olecranon fracture was treated non-operatively for minimally displaced fractures, although one needed internal fixation. All displaced T-condylar fractures required open reduction and internal fixation. There were no complications of non-union, mal-union, avascular necrosis, cubitus valgus or tardy ulnar palsy. Healing and return of normal function occurred in all, although six patients had minor loss of extension.

Conclusion: We found no obvious difference in the outcome between the isolated displaced LCM fractures described in the literature and our complex LCM group. However the importance of careful assessment of the preoperative radiographs and testing of elbow stability by examination under anaesthesia is stressed.