A Clinical Study of Lateral Condyle Fracture of Distal Humerus in Children

Lim, Bong Yeol; Cheong, Hee Young; Yoo, Byung Ryoung; Shin, Dong Bai

Abstract

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.