Treatment of the dislocation of the elbow associated with lateral condyle fracture of the humerus in children

WU Yong-tao; SUN Chuan; WANG Bing; JIANG Hai; WU Ge; MIAO Wu-sheng

doi:10.3969/j.issn.2095-252X.2017.07.005

Abstract：Objective To investigate the clinical characteristics, diagnosis and treatment protocols and outcomes of dislocation of the elbow associated with lateral condyle fracture of the humerus in children. Methods From March 2012 to February 2015, 12 children with dislocation of the elbow associated with lateral condyle fracture of the humerus were treated in our hospital. There were 3 females and 9 males, with 8 in the left and 4 in the right. The age at the time of injury ranged from 6 to 13 years. The cause of injury was falling from a height. All patients were presented to our hospital at 2 to 8 hours after the injury. The types of elbow dislocation were classified by the relative position of the proximal radioulnar joint to the distal humerus, and the types of lateral condyle fracture of the humerus were classified by the Milch fracture system. A closed reduction of elbow dislocation was performed during the initial evaluation. Fractures were then treated based on the amount of residual displacement of the lateral condyle. If the postmanipulation displacement was measured at < 2 mm, a percutaneous pinning was performed. For those with > 2 mm of displacement following closed manipulation, an open reduction and internal fixation with smooth Kirschner wire was undertaken. Results The direction of elbow dislocation was posteromedial in 10 patients and posterolateral in 2 patients. The group involved 1 case of type I and 11 cases of type Ⅱ as classified by the Milch fracture system. A closed reduction maneuver was performed, with 1 failed case. Nine patients with > 2 mm of displacement received open reduction and internal fixation with smooth Kirschner wire and 3 patients with percutaneous pinning. All patients were followed up for 12 months in average. The radiographs at the latest follow-up showed no patients had avascular necrosis of the distal humerus, nonunion or malunion. According to Hardacre elbow score system, there were 5 excellent cases and 7 good cases. The children's daily life and study were not obviously affected. Conclusions The clinical diagnosis of dislocation of the elbow associated with lateral condyle fracture of the humerus is hard, and the children's age, sensation of reduction and necessary imaging examination must be relied on, so as to avoid the misdiagnosis. The therapy should be selected based on the amount of residual displacement of the lateral condyle, and good clinical outcomes could be obtained.