Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type <b>Ⅱ</b> lateral condylar humerus fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Xiwei ^1,2 , MA Hailong ¹ , LIU Fang ¹ , GUAN Zhiye ¹ , ZHANG Sicheng ¹ ,  SUN Jun ¹

1. Department of Orthopedics, Anhui Provincial Children’s Hospital, Hefei Anhui, 230061, P. R. China;
2. The Fifth Clinical College of Anhui Medical University, Hefei Anhui, 230061, P. R. China;

Corresponding author：

SUN Jun, Email: sunjun500@aliyun.com

Keywords：

Lateral condylar humerus fracture; ultrasound; arthrography; internal fixation; child

DOI：

10.7507/1002-1892.202305017

Video：

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Objective To compare the effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ lateral condylar humerus fracture (LCHF) in children. Methods A clinical data of 101 children with Jakob type Ⅱ LCHF, who met the selection criteria and were admitted between April 2021 and April 2022, was retrospectively analyzed. Of them, 47 cases were treated with ultrasound-assisted Kirschner wire fixation (group A), and 54 cases with arthrography-assisted surgery (group B). There was no significant difference in gender, age, cause of injury, fracture side, and disease duration between groups (P>0.05). Intraoperative fluoroscopy times, operation time, and hospital stay, Flynn elbow joint function score, and postoperative complications were recorded and compared between groups. X-ray examination was performed to observe the healing of fracture, and measure the carrying angle and the shaft-condylar angle (SCA). Results The success rate of closed reduction was significantly higher in group A than in group B (P<0.05), and the intraoperative fluoroscopy times was significantly less in group A than in group B (P<0.05). There was no significant difference in operation time and hospital stay between groups (P>0.05). All children in both groups were followed up 12-18 months, with an average of 13.6 months. X-ray reexamination showed that the fractures of both groups healed, and the difference in healing time was not significant (P>0.05). At last follow-up, there was no significant difference in carrying angle and SCA between unaffected side and affected side in both groups and between groups A and B in affected side (P>0.05). There was no significant difference in Flynn elbow joint function score between groups (P>0.05). There were 18 cases of lateral spurs formation in group A, 1 case of pinning infection and 26 cases of lateral spurs formation in group B, and there was no significant difference in the incidence of the above complications (P>0.05). Conclusion Compared with the arthrography, the ultrasound-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ LCHF in children can avoid the open reduction and decrease the number of intraoperative fluoroscopy, and obtain the good effectiveness.

Citation： SUN Xiwei, MA Hailong, LIU Fang, GUAN Zhiye, ZHANG Sicheng, SUN Jun. Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type Ⅱ lateral condylar humerus fractures in children. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 952-957. doi: 10.7507/1002-1892.202305017 Copy

1.	Abzug JM, Dua K, Kozin SH, et al. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg, 2020, 28(1): e9-e19.
2.	Shaerf DA, Vanhegan IS, Dattani R. Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder Elbow, 2018, 10(2): 114-120.
3.	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(4): 430-436.
4.	Knapik DM, Gilmore A, Liu RW. Conservative management of minimally displaced (≤2 mm) fractures of the lateral humeral condyle in pediatric patients: a systematic review. J Pediatr Orthop, 2017, 37(2): e83-e87.
5.	Flynn JC. Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop, 1989, 9(6): 691-696.
6.	Fornari ED, Suszter M, Roocroft J, et al. Childhood obesity as a risk factor for lateral condyle fractures over supracondylar humerus fractures. Clin Orthop Relat Res, 2013, 471(4): 1193-1198.
7.	伍兴, 李雄涛, 夏敬冬, 等. 超声引导闭合复位内固定治疗轻度移位的儿童肱骨外髁骨折. 中华小儿外科杂志, 2019, 40(10): 939-943.
8.	Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6): 350-358.
9.	Xie LW, Wang J, Deng ZQ, et al. Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord, 2020, 21(1): 707. doi: 10.1186/s12891-020-03738-9.
10.	Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
11.	Xie LW, Deng ZQ, Zhao RH, et al. Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by > 4 mm: an observational cross-sectional study. BMC Musculoskelet Disord, 2021, 22(1): 985. doi: 10.1186/s12891-021-04880-8.
12.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
13.	刘永, 袁毅, 姚杰, 等. 不同Jacob分型的儿童陈旧性肱骨外髁骨折术后功能研究. 中华小儿外科杂志, 2018, 39(2): 137-140.
14.	Li XT, Shen XT, Wu X, et al. Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children. J Shoulder Elbow Surg, 2021, 30(9): 2113-2119.
15.	伍兴, 夏敬冬, 李雄涛, 等. 超声和关节造影辅助下治疗儿童肱骨远端骨骺分离的临床疗效分析. 中华小儿外科杂志, 2022, 43(1): 50-55.
16.	Sierra LAM, Katsnelson JY, Pineda DM. Occupational radiation exposure among general surgery residents: should we be concerned? J Surg Educ, 2022, 79(2): 463-468.
17.	Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.

1. Abzug JM, Dua K, Kozin SH, et al. Current concepts in the treatment of lateral condyle fractures in children. J Am Acad Orthop Surg, 2020, 28(1): e9-e19.
2. Shaerf DA, Vanhegan IS, Dattani R. Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder Elbow, 2018, 10(2): 114-120.
3. 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(4): 430-436.
4. Knapik DM, Gilmore A, Liu RW. Conservative management of minimally displaced (≤2 mm) fractures of the lateral humeral condyle in pediatric patients: a systematic review. J Pediatr Orthop, 2017, 37(2): e83-e87.
5. Flynn JC. Nonunion of slightly displaced fractures of the lateral humeral condyle in children: an update. J Pediatr Orthop, 1989, 9(6): 691-696.
6. Fornari ED, Suszter M, Roocroft J, et al. Childhood obesity as a risk factor for lateral condyle fractures over supracondylar humerus fractures. Clin Orthop Relat Res, 2013, 471(4): 1193-1198.
7. 伍兴, 李雄涛, 夏敬冬, 等. 超声引导闭合复位内固定治疗轻度移位的儿童肱骨外髁骨折. 中华小儿外科杂志, 2019, 40(10): 939-943.
8. Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6): 350-358.
9. Xie LW, Wang J, Deng ZQ, et al. Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning. BMC Musculoskelet Disord, 2020, 21(1): 707. doi: 10.1186/s12891-020-03738-9.
10. Pennock AT, Salgueiro L, Upasani VV, et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for type Ⅱ lateral condyle humerus fractures in children displaced >2 mm. J Pediatr Orthop, 2016, 36(8): 780-786.
11. Xie LW, Deng ZQ, Zhao RH, et al. Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by > 4 mm: an observational cross-sectional study. BMC Musculoskelet Disord, 2021, 22(1): 985. doi: 10.1186/s12891-021-04880-8.
12. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
13. 刘永, 袁毅, 姚杰, 等. 不同Jacob分型的儿童陈旧性肱骨外髁骨折术后功能研究. 中华小儿外科杂志, 2018, 39(2): 137-140.
14. Li XT, Shen XT, Wu X, et al. Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children. J Shoulder Elbow Surg, 2021, 30(9): 2113-2119.
15. 伍兴, 夏敬冬, 李雄涛, 等. 超声和关节造影辅助下治疗儿童肱骨远端骨骺分离的临床疗效分析. 中华小儿外科杂志, 2022, 43(1): 50-55.
16. Sierra LAM, Katsnelson JY, Pineda DM. Occupational radiation exposure among general surgery residents: should we be concerned? J Surg Educ, 2022, 79(2): 463-468.
17. Pribaz JR, Bernthal NM, Wong TC, et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Pediatr Orthop, 2012, 32(5): 456-460.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type Ⅱ lateral condylar humerus fractures in children

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