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Managing Neglected Humerus Fractures in Kids

This document discusses the management of neglected fractures of the lateral condyle of the humerus in pediatric patients. It summarizes that these fractures are commonly missed or misdiagnosed, leading to delayed presentation beyond 3 weeks. The study examined 50 cases of neglected lateral condyle fractures in patients aged 2-10 years. Good results were found in 40 cases while 10 cases resulted in non-union, stiffness, or mild swelling. Common causes of delayed presentation included fractures being initially missed or misinterpreted on low quality x-rays. Proper clinical examination and operative techniques like lateral approach fixation with K-wires achieved good outcomes in most cases.

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Purushotham Nalamati
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387 views33 pages

Managing Neglected Humerus Fractures in Kids

This document discusses the management of neglected fractures of the lateral condyle of the humerus in pediatric patients. It summarizes that these fractures are commonly missed or misdiagnosed, leading to delayed presentation beyond 3 weeks. The study examined 50 cases of neglected lateral condyle fractures in patients aged 2-10 years. Good results were found in 40 cases while 10 cases resulted in non-union, stiffness, or mild swelling. Common causes of delayed presentation included fractures being initially missed or misinterpreted on low quality x-rays. Proper clinical examination and operative techniques like lateral approach fixation with K-wires achieved good outcomes in most cases.

Uploaded by

Purushotham Nalamati
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Introduction
  • Aim of the Study
  • Materials and Methods
  • Results
  • Causes of Late Presentation
  • Clinical Examination
  • Operative Techniques
  • Holding the Reduction while Pinning
  • Position of Elbow while Pinning
  • Counselling of Patient
  • Scoring System for Outcome
  • Function Grading
  • Fish Tail Deformity
  • Case Studies
  • Conclusion

TIPS & TRICKS IN THE

MANAGEMENT OF
NEGLECTED FRACTURE
LATERAL CONDYLE HUMERUS
IN
PEDIATRIC AGE GROUP
Introduction
 Neglected fracture lateral condyle of humerus
is frequently encountered in day-to-day
orthopaedic practice
 These are patients which reported beyond 3
weeks of injury
Aim of the study
 To know causes for delayed presentation
 To know associated co-morbidities
 Dilemna in diagnosis
 Fixation techniques
Materials and Methods
 We studied 50 such cases
 Age group: 2 yrs-10 yrs
 Duration: from December 2015 to Dec 2017
 Under G.A. Under tourniquet
 Lateral approach, fragment reduced and fixed
with 2-3 K-wire
 Immobilisation for 3-4 weeks
 K-wire removal at 6 weeks
RESULTS
 Out of 50 such cases
 40 – Good results
 10 – poor results
 Non-union
 Stiffness
 Mild swelling
Causes of Late Presentation
1. Undiagnosed cases :
taken as a soft tissue injury
No X-ray done
2. X-ray done :
Poor X-ray quality
Misinterpreted even by qualified
radiologists
3. Fracture diagnosed, Slab applied
But Fragment displaced in slab
Clinical examination
 There’s no substitute for good clinical
examination
 Keep a thumb over lat. condyle and rotate
forearm in supination and pronation
 A snap or click under the thumb will clear the
picture and decide whether just immobilisation
or ORIF is needed
Operative Techniques
1. Lateral approach, Intervening space between
triceps and brachio-radialis

2. Avoid too much soft tissue dissection-it


hampers vascularity of fragment and promotes
non-union
3. Create a space for displaced fragment because
space previously occupied by lat fragment is
now filled with lot of fibrous tissue

4. Nibble the medial surface of metaphysis and


fresh fracture site of lat condyle with knife till
bleeding surface appear on both side
Holding the reduction while pinning
 Three methods are popular
1. Holding reduction with joystick and do
pinning
2. Holding reduction with clamp and do pinning
3. Holding reduction manually by thumb and
index finger and do pinning
Position of elbow while pinning
 Usually we put K wire keeping elbow by side
of body and forearm lying on chest
 In this position, forearm is in 45 degree internal
rotation
 And if one is not careful, lat fragment shifts a
bit forward and internally rotates while
pinning
 Which is not appreciated by naked eye or even
in c-arm
 It gives bad result
 We recommend to keep elbow in air, forearm
fully supinated and in this position we do
pinning
 This gave us more secure reduction
Counselling of patient :Very important
 Counselling of parents, relatives, and even
newer relatives who surface with each visit is
very difficult
 So not only verbal but written consent is must
 Scoring System -18th System are Available .
 There is no Correlation between the results of these
scoring system and patients satisfaction.
 Pt with the same level of satisfaction could perform
differently at the scoring system .
 Many scoring system have been used to evaluate
elbow function but we are still far from a single out
come evaluation system which is reliable, valid and
sensitive to the changes of clinical importance which
takes into account both patients and physicians
prospective and which is short and practical to use.
Scoring System for outcome
Function ROM Carrying Angle Point Scored

No Pain or 0-140 Valgus 7-10 3


weakness

Occasional Pain >15-125 Valgus. <20, 2


Varus. <0

Pain after heavy >30 -110 Valgus 20-30 1


work Varus 0-15

Pain with normal <-30-15 Valgus >30 0


activity Varus >15
Motor or sensory
loss
Function grading
 Excellent- 6
 Good -5
 Fair-4
 Poor-<4

 Accurate measurement of carrying angle is


difficult when elbow cannot be fully extended
Fish tail deformity-
 No-Clinical significance
 This radiological defect is produced from
an abnormal fusion with loss of the
ossification link between the trochlea and
capitulum centers with a resultant
deficiency of the lateral tip of the
trochlea.(Wedsworth 1972)
CASE NO-1
CASE NO-1
CASE NO-1
CASE NO-1
CASE NO-2
CASE NO-2
CASE NO-2
CASE NO-3
CASE NO-3
Case No-4
Case No-4
Case No-5
Case NO-5
Thanks

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