Fractures of the Humeral Ulnar Condyle in Children – a Rare but Complicated Injury

Abstract

Background Ulnar humeral condyle fractures are rare paediatric elbow fractures, classified as Salter-Harris IV paediatric elbow injuries. Due to constant radiological changes in the elbow with varying manifestation of ossification centres as well as late ossification of the trochlea, diagnosis of these injuries is challenging. To avoid long-term complications, the treating surgeon should be familiar with the rare injury picture, diagnostics and adequate therapeutic measures.

Material and Methods The present retrospective study includes data on all paediatric cases from 2002 to 2019 with primary or secondary treatment at a paediatric traumatology centre for ulnar condyle fracture with a minimum follow-up of 12 months. Range of motion, joint stability under valgus and varus stress as well as axial ratios of the injured and uninjured side were evaluated in a clinical follow-up examination. The Mayo Elbow Performance Score was used to objectify functional results.

Results 20 children, average age 8.6 years (4 – 13) and average follow-up time 25 months, were included. Radiological evaluation based on Jakob and Fowles classification revealed a type I fracture in three cases, a type II fracture in one case and a type III fracture in 16 cases. Three cases were treated nonoperatively with an upper arm cast. 17 children were treated with open reduction and internal fixation. Diagnosis of three fractures was delayed. No postoperative complications such as infections, nerve damage or nonunions. 15 children showed free elbow function. Three children showed slightly restricted elbow extension by less than 10° and two by 10°–20°. All children showed free pro/supination. 18 children showed a physiological and bilaterally identical arm axis compared to the uninjured side. Two children showed a slightly increased cubitus valgus with a 5 – 10° difference between sides. Radiologically, two children with delayed fracture treatment showed partial necrosis of the trochlea. The Mayo Elbow Score showed good (2) to excellent results in all children (18).

Conclusion Very good clinical and functional results can be expected if the injury is diagnosed without delay followed by adequate therapy. Misdiagnosis of ulnar condyle fractures can be associated with the development of nonunions and functional restrictions as well as, after operative therapy, trochlear necrosis. Children up to the age of 6 in particular are at risk of misdiagnosis due to faulty assessment of the cartilaginous trochlea.

Key words

children - ulnar condyle fracture - nonunion - complications

Publication History

Article published online:
25 November 2020

• References/Literatur

• 1 Chacha PB. Fracture of the medical condyle of the humerus with rotational displacement. Report of two cases. J Bone Joint Surg Am 1970; 52: 1453-1458
• 2 Fowles JV, Kassab MT. Displaced fractures of the medial humeral condyle in children. J Bone Joint Surg Am 1980; 62: 1159-1163
• 3 Sağlam N, Saka G, Kurtulmuş T. et al. Medial humeral condyle fractures in adolescents: treatment and complications. Eur J Orthop Surg Traumatol 2014; 24: 1101-1105 doi:10.1007/s00590-013-1288-9
• 4 Kilfoyle RM. Fractures of the medial condyle and epicondyle of the elbow in children. Clin Orthop Relat Res 1965; 41: 43-50
• 5 Bensahel H, Csukonyi Z, Badelon O. et al. Fractures of the medial condyle of the humerus in children. J Pediatr Orthop 1986; 6: 430-433 doi:10.1097/01241398-198607000-00007
• 6 Papavasiliou V, Nenopoulos S, Venturis T. Fractures of the medial condyle of the humerus in childhood. J Pediatr Orthop 1987; 7: 421-423 doi:10.1097/01241398-198707000-00008
• 7 Leet AI, Young C, Hoffer MM. Medial condyle fractures of the humerus in children. J Pediatr Orthop 2002; 22: 2-7
• 8 Ghawabi MH. Fracture of the medial condyle of the humerus. J Bone Joint Surg Am 1975; 57: 677-680
• 9 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
• 10 Pirker ME, Weinberg AM, Hollwarth ME. et al. Subsequent displacement of initially nondisplaced and minimally displaced fractures of the lateral humeral condyle in children. J Trauma 2005; 58: 1202-1207 doi:10.1097/01.ta.0000169869.08723.c8
• 11 Song KS, Ramnani K, Cho CH. et al. Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child. J Orthop Traumatol 2011; 12: 219-222 doi:10.1007/s10195-011-0155-x
• 12 Fahey JJ, OʼBrien ET. Fracture-separation of the medial humeral condyle in a child confused with fracture of the medial epicondyle. J Bone Joint Surg Am 1971; 53: 1102-1104
• 13 Ippolito E, Tudisco C, Farsetti P. et al. Fracture of the humeral condyles in children: 49 cases evaluated after 18–45 years. Acta Orthop Scand 1996; 67: 173-178 doi:10.3109/17453679608994666
• 14 Haraldsson S. On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand Suppl 1959; 38: 1-232
• 15 Ryu K, Nagaoka M, Ryu J. Osteosynthesis for nonunion of the medial humeral condyle in an adolescent: a case report. J Shoulder Elbow Surg 2007; 16: e8-e12 doi:10.1016/j.jse.2006.07.011