DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20220615

A displaced T type intercondylar distal humerus fracture with radial nerve palsy in a 10-year-old treated by closed reduction and K wire fixation

Nikhilesh Nair, Mohamed Sameer, J. K. Giriraj, Ghantasala Navaneeth

Abstract


T type intercondylar fractures of the distal hummers in the pediatric age group is an extremely rare injury. These fractures are difficult to diagnosed as they can be mistaken for extension type injuries. The few clinal trials on the management of the fracture, it is widely regarded that the accepted method of treatment is open reduction and rigid internal fixation. It is easier to ensure stable articular reconstruction of the intra articular fragments by this method. Open reduction and internal fixation of there fractures are associated with high complication rate, which include wound site problems, non-union due to periosteal stripping, heterotrophic ossification and iatrogenic nerve injury. Large soft tissue dissection can also lead to vascular compromise and significant scar tissue which is associated with a stiff elbow. We present a case of a 10-year-old boy who sustained an intercondylar fracture with radial nerve palsy which was treated by closed reduction and Kirshner wire fixation with excellent results at 1 year follow up.


Keywords


Pediatric, Fracture, Elbow, Intercondylar, Closed reduction, K wire, Trauma

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References


Maylahn DJ, Fahey JJ. Fractures of the elbow in children. JAMA. 1958;166:220-8.

Evans EM. Supracondylar-Y fractures of the humerus. J Bone Joint Surg Br. 1953;35:381.

Beaty JH, Kasser JR, The elbow. Edit-Beaty JH, Kasser JR. Physeal fractures, apophyseal injuries of the distal humerus, avascular necrosis of the trochlea, and T-condylar fractures. Rockwood & Wilkins’ Fractures in Children Lippincott Willams and Wilkins, Philadelphia. 2001;623-703.

Anari JB, Neuwirth AL, Carducci NM, Donegan DJ, Baldwin KD: Pediatric T- condylar humerus fractures: A systematic review. J Pediatr Orthop. 2015;37(1):36-40.

Gruber MA, Hudson OC. Supracondylar fracture of the humerus in children. End-result study of open reduction. J Bone Joint Surg Am. 1964;46:1245-52.

Papavasiliou VA, Beslikas TA. T-condylar fractures of the distal humeral condyles during childhood: an analysis of six cases. J Pediatr Orthop. 1986;6:302-5.

Weiland AJ, Meyer S, Tolo VT, Berg HL, Mueller J. Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years. J Bone Joint Surg Am. 1978;60:657-61.

Yamaguchi K, Sweet FA, Bindra R. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am. 1997;79:1653-62.

Jarvis JG, D’Astous JL. The pediatric T- supracondylar fracture. J Pediatr Orthop. 1984;4:697-9.

Kocher MS, Kasser JR, Waters PM. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am. 2007;89:706-12.

Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1998;18(5):686-90.

Shannon FJ, Mohan P, Chacko J, D’Souza LG. “Dorgan’s” percutaneous lateral cross-wiring of supracondylar fractures of the humerus in children. J Pediatr Orthop. 2004;24(4):376-9.

Eidelman M, Hos N, Katzman A, Bialik V. Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by ‘flexion-extension cross-pinning’ technique. J Pediatr Orthop B. 2007;16(3):221-4.

Yi-Meng Y, Kocher, Mininder S. Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children Surgical Technique. J Bone Joint Surg. 2008;20-30.

Beghin JL, Bucholz RW, Wenger DR. Intercondylar fractures of the humerus in young children. J Bone Joint Surg Am. 1982;64:1083-6.

Ducic S, Bumbasirevic M, Brdar R, Stojanovic B, Djordjevic M. Paediatric T-condylar fractures of the humerus: clinical ex- perience and outcomes in 19 cases. Injury. 2019;45:1876-9.