gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Posteromedial dislocation of the elbow with lateral humeral condyle fracture in children – Arthrography is useful for distinguishing between dislocation or epiphyseal separation

Meeting Abstract

Search Medline for

  • presenting/speaker Kayo Tsuzawa - Showa University School of Medicine, Shinagawa Ward, Tokyo, Japan
  • Keikichi Kawasaki - Showa University School of Medicine, Shinagawa Ward, Tokyo, Japan
  • Katsunori Inagaki - Showa University School of Medicine, Shinagawa Ward, Tokyo, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1685

doi: 10.3205/19ifssh0079, urn:nbn:de:0183-19ifssh00792

Published: February 6, 2020

© 2020 Tsuzawa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Posteromedial dislocation of the elbow with lateral humeral condyle fracture is rare in pediatric elbow injury. It is often difficult to distinguish between elbow dislocation with lateral condyle fracture and epiphyseal separation of the distal humerus, especially in younger infants whose ossification centers are not yet apparent. We report 6 cases of the posteromedial shift of the forearm with the distal humeral fractures and discuss the importance of the diagnosis of the fracture patterns.

Methods: Retrospective data were collected for the cases of distal humeral fractures with posteromedial shift of the forearm treated at our hospital.

Results and Conclusions: There were six cases of these fractures, which five were boys and one was a girl. Mean age at the injury was 7.5 years, ranging from 0 to 12 years. Four cases were elbow dislocation with lateral humeral condyle fracture and two were epiphyseal separation of the distal humerus. All four cases of lateral humeral condyle fractures had an appearance of an ossification center of the lateral condyle, hence were easily diagnosed. However, trochlear of these three cases hadn't been fully ossified and were difficult categorize according to Milch's classification. Three cases were treated by fixation with tension band wiring (TBW), and one was with TBW and K-wire. Two of epiphyseal separation of the distal humerus were diagnosed by arthrography because their ossification centers didn't appear. One case underwent surgical treatment by pinning and one was treated by closed reduction and casting. One postoperative patient had painless flexion of elbow motion to 120 degree, but others had no clinical symptom after all.

The epiphyseal separation of the distal humerus is difficult to diagnose when the ossification center is not yet apparent and is radiographically assessed by the alignment of the radial axis and the capitulum of the humerus. The injury is likely to be an elbow dislocation with lateral condyle fracture if the reduction position is kept, but we should confirm the fracture pattern by arthrography before the treatment. The lateral condyle fracture is Salter-Harris type 4 epiphyseal separation and some report shows the importance of the Milch's classification. One of our cases needed arthrography for the assessment of elbow joint at the removal of wires. We should evaluate the posteromedial shift with the humeral fracture by arthrography at the time of reduction or before the operation.