Diagnosis and treatment experience of the humeral condylar fracture in children

WANG Lai-xi; CHENG Fu-li; JING Xiao-bo; LIU Yong-li; SHEN Zi-long

doi:10.3969/j.issn.2095-252X.2017.07.004

Abstract：Objective To investigate the diagnosis and treatment of humeral condylar fractures in children to improve the experience. Methods The clinical data of 9 children with humeral condylar fractures treated in our hospital from 2010 to 2015 were retrospectively analyzed, including Kilfoyle-type Ⅱ in 3 cases, Kilfoyle-type Ⅲ in 6 cases and combined elbow dislocation in 2 cases. A detailed preoperative physical examination of elbow joint swelling, tenderness and deformity was performed, as well as the change of posterior cubital triangle. All the patients underwent anterioposterior and lateral X-ray and CT examinations of the elbow. One child of 5 years old underwent MRI examination of the parallel elbow to confirm the diagnosis. Open reduction was performed with 2 - 3 Kirschner wires penetrating the fixed end. After 3 weeks of cast immobilization, elbow functional exercise was performed. Results All fractures healed well after surgery, without elbow deformity. Two patients had limitation of elbow joint function, among whom 1 patient suffered old fracture. No wound infection, iatrogenic vascular injury, internal fixation loosening, bone necrosis, myositis ossificans or other complications occurred. According to Dhillon scoring standard, there were 7 excellent cases, 1 good case and 1 fair case. Conclusions Misdiagnosis and missed diagnosis of humeral condylar fractures in children often happen. Both X-ray examination and physical examination should be performed. X-ray examination should be paid full attention in younger children when the distal humeral epiphysis is developing. If necessary, the elbow joint MRI examination should also be performed. Early diagnosis and reduction fixation should be done in the treatment.