Lateral Condylar Humerus Fractures
Andrea S. Bauer, MD
Closed Reduction Percutaneous Pinning and/or Screw Fixation
Equipment
Smooth C-wires (0.45 and 0.62 diameter)
Power drill
Fluoroscopy
Arthrographic dye (Optiray (Ioversol) mixed 50:50 with sterile saline)
 Figure 6-1 ▪ Lateral condylar humerus fracture with less than 2 mm displacement that can be treated closed (A) versus illustration of >2 mm displacement treated with operative fixation (B). (A, Reprinted with permission from Beaty JH, Kasser JR. Rockwood and Green’s Fractures in Children. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010. B, Reprinted with permission from Waters PM, Bae DS. Pediatric Hand and Upper Limb Surgery. 1st ed. Philadelphia, PA: Wolters Kluwer Health; 2013 and Redrawn from Jakob R, Fowles JV, Rang M, et al. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br. 1975;57:430-436.) |
 Figure 6-2 ▪ OR set up with image intensifier as table for CRPP and potential arthrographic imaging. |
 Figure 6-3 ▪ Placement of two lateral entry divergent pins percutaneously. |
Technique
Under sterile conditions, use the flat fluoroscopic image intensifier as horizontal support for the elbow and upper arm (Figure 6-2)
Place two smooth C-wires with sharp tip into the fracture fragment perpendicular to the fracture line to reduce fracture to anatomic alignment (Figure 6-3).
Confirm reduction with fluoroscopy and then drive wires across the fracture obliquely into proximal metaphysis and then obtain bicortical fixation
Add a third pin if necessary
Alternatively, a compression screw can be used in the metaphyseal fragment. A screw across physis does not seem to impair growth (Figure 6-4).
Short-term smooth pins across olecranon fossa are not harmful. A screw in olecranon fossa is problematic and will need to be removed.
If appropriate, check reduction with arthrographic exam (Figure 6-4)
Place needle in olecranon fossa
Inject sterile saline and check for free flow back to confirm intra-articular placement of needle. It is not hard to think you are in the joint and not be. Avoiding extravasation of dye is important.
With IV tubing attached to needle, slowly inject dye (Optiray (Ioversol) mixed 50:50 with sterile saline) while checking joint surfaces.
Confirm anatomic reduction joint
If not anatomic, open reduction is required.
Do NOT accept less than anatomic reduction (Figure 6-5)
Lateral Condylar Humerus Fractures
Open Reduction Internal Fixation
Indications for Open Reduction
Displacement of greater than 2 mm with intra-articular displacement usually with significant malrotation (Figure 6-6)
Figure 6-4 ▪ Physeal screw fixation with arthrographic imaging of joint reduction.
Figure 6-5 ▪ After unsuccessful CRPP of displaced lateral condyle fracture noted by skin pin holes, incision is being made for ORIF to obtain anatomic alignment.
Figure 6-6 ▪ Markedly displaced lateral condylar fracture indicated for ORIF. (Reprinted with permission from Beaty JH, Kasser JR. Rockwood and Green’s Fractures in Children. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.)
Figure 6-7 ▪ Incision outlined for exposure for ORIF.
Unsuitable for closed reduction and percutaneous pinning
Unacceptable closed treatmentRelated posts:
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