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T-condylar humerus fracture in children: treatment options and outcomes

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Abstract

Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns.

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References

  1. Kanellopoulos AD, Yiannakopoulos CK (2004) Closed reduction and percutaneous stabilization of paediatric T-condylar fractures of the humerus. J Pediatr Orthop 24:13–16

    Article  PubMed  Google Scholar 

  2. Julfiqar, Pant A, Huda N, Ahmed W (2013) Closed reductions and percutaneous ‘K’ wire fixation for adolescent intercondylar fractures of the distal humerus. J Clin Diagn Res 7:1666–1668

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Ruiz AL, Kealey WD, Cowie HG (2001) Percutaneous pin fixation of intercondylar fractures in young children. J Pediatr Orthop B 10:211–213

    CAS  PubMed  Google Scholar 

  4. Toniolo MR, Wilkins KE (1996) T-condylar fractures. In: Rockwood CA, Wilkins KE, Beaty JH (eds) Fractures in children, 4th edn. Lippincott-Raven, Philadelphia, pp 653–904

    Google Scholar 

  5. Rockwood C, Wilkins K, King R (1991) Fractures in children, 3rd edn. JB Lippincott, New York

    Google Scholar 

  6. Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Henley MB (2006) The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 20:164–171

    PubMed  Google Scholar 

  7. Ring D, Gulotta L, Chin K, Jupiter JB (2004) Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 18:446–449

    Article  PubMed  Google Scholar 

  8. Throckmorton TW, Zarkadas PC, Steinmann SP (2007) Distal humerus fractures. Hand Clin 23:457–469

    Article  PubMed  Google Scholar 

  9. Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elb Surg 10:380–382

    Article  CAS  Google Scholar 

  10. Re PR, Waters PM, Hresko T (1999) T-condylar fractures of the distal humerus in children and adolescents. J Pediatr Orthop 19:313–318

    CAS  PubMed  Google Scholar 

  11. Papavasiliou VA, Beslikas TA (1986) T-condylar fractures of the distal humeral condyles during childhood: an analysis of six cases. J Pediatr Orthop 6:302–305

    Article  CAS  PubMed  Google Scholar 

  12. Pajarinen L, Bjorkenheim JM (2002) Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elb Surg 11:48–52

    Article  Google Scholar 

  13. Pollock JW, Faber KJ, Athwal GS (2008) Distal humerus fractures. Orthop Clin North Am 39:187–200

    Article  PubMed  Google Scholar 

  14. Waddell JP, Hatch J, Richards RR (1988) Supracondylar fractures of the humerus: results of surgical treatment. J Trauma 28:1615–1621

    Article  CAS  PubMed  Google Scholar 

  15. Maylahn DJ, Fahey JJ (1958) Fractures of the elbow in children; review of three hundred consecutive cases. J Am Med Assoc 166:220–228

    Article  CAS  PubMed  Google Scholar 

  16. Kraus R (2014) The paediatric vs. the adolescent elbow: some insight into age-specific treatment. Eur J Trauma Emerg Surg 40:15–22

    Article  CAS  PubMed  Google Scholar 

  17. Beck NA, Ganley TJ, McKay S, Tomlinson L, Ahn J, Flynn JM, Baldwin K (2014) T-condylar fractures of the distal humerus in children: does early motion affect final range of motion? J Child Orthop 8:161–165

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ducic S, Bumbasirevic M, Brdar R, Stojanovic B, Djordjevic M (2014) Paediatric T-condylar fractures of the humerus: clinical experience and outcomes in 19 cases. Injury 45:1876–1879

    Article  PubMed  Google Scholar 

  19. Cheng JC, Wing-Man K, Shen WY, Yurianto H, **a G, Lau JT, Cheung AY (1998) A new look at the sequential development of elbow-ossification centres in children. J Pediatr Orthop 18:161–167

    CAS  PubMed  Google Scholar 

  20. Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg 63:872–877

    Article  CAS  PubMed  Google Scholar 

  21. Slongo T, Audige L, Schlickewei W, Clavert JM, Hunter J, International Association for Paediatric Traumatology (2006) Development and validation of the AO paediatric comprehensive classification of long bone fractures by the paediatric expert group of the AO foundation in collaboration with AO clinical investigation and documentation and the international association for paediatric traumatology. J Pediatr Orthop 26:43–49

    Article  PubMed  Google Scholar 

  22. Bell P, Scannell BP, Loeffler BJ, Brighton BK, Gaston RG, Casey V, Peters ME, Frick S, Cannada L, Vanderhave KL (2017) Adolescent distal humerus fractures: ORIF versus CRPP. J Pediatr Orthop 37:511–520

    Article  PubMed  Google Scholar 

  23. Mok CY, Lui TH (2013) T-condylar fractures of the distal humerus in children: report on three cases. BMJ Case Rep 2013

  24. Kasser JR, Richards K, Millis M (1990) The triceps dividing approach to open reduction of complex distal humeral fractures in adolescents: a cybex evaluation of triceps function and motion. J Pediatr Orthop 10:93–96

    Article  CAS  PubMed  Google Scholar 

  25. Remia FL, Richards K, Waters MP (2004) The Bryan-Morrey triceps-sparing approach to open reduction of T-condylar humeral fractures in adolescents Cybex evaluation of triceps function and elbow motion. J Pediatr Orthop 24:615–619

    Article  PubMed  Google Scholar 

  26. Cook JB, Riccio AI, Anderson T, Chen W, Shaha SH, Wimberly RL (2016) Outcomes after surgical treatment of adolescent intra-articular distal humerus fractures. J Pediatr Orthop 36:773–779

    Article  PubMed  Google Scholar 

  27. Ljungquist KL, Beran MC, Awan H (2012) Effects of surgical approach on functional outcomes of open reduction and internal fixation of intra-articular distal humeral fractures: a systematic review. J Shoulder Elb Surg 21:126–135

    Article  Google Scholar 

  28. Dreyfuss D, Eidelman M (2014) Treatment of complex intercondylar humeral fractures in adolescents by open reduction and internal fixation through the transolecranon approach. J Pediatr Orthop B 23:364–368

    Article  PubMed  Google Scholar 

  29. Jarvis JG, D’Astous JL (1984) The paediatric T-supracondylar fracture. J Pediatr Orthop 4:697–699

    Article  CAS  PubMed  Google Scholar 

  30. Jupiter JB, Neff U, Holzach P, Allgower M (1985) Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am 67:226–239

    Article  CAS  PubMed  Google Scholar 

  31. Pajarinen J, Bjorkenheim JM (2002) Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of two years in a series of 18 patients. J Shoulder Elb Surg 11:48–52

    Article  Google Scholar 

  32. Morrey BF, Adams RA (1992) Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 74:479–490

    Article  CAS  PubMed  Google Scholar 

  33. Anari JB, Neuwirth AL, Carducci NM, Donegan DJ, Baldwin KD (2017) Paediatric T-condylar humerus fractures: a systematic review. J Pediatr Orthop 37:36–40

    Article  PubMed  Google Scholar 

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Funding

This paper is supported by Ministry of Science, Republic of Serbia, Project No. 175048.

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Authors and Affiliations

  1. School of Medicine, University of Belgrade, Belgrade, 11000, Serbia

    Sinisa Ducic, Borko Stojanovic, Mikan Lazovic, Bojan Bukva, Vladimir Radlovic, Vojislav Bumbasirevic & Miroslav L. Djordjevic

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  1. Sinisa Ducic
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  2. Borko Stojanovic
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  3. Mikan Lazovic
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  4. Bojan Bukva
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  5. Vladimir Radlovic
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  6. Vojislav Bumbasirevic
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  7. Miroslav L. Djordjevic
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Contributions

Ducic S had the idea, concept and drafted the manuscript; Stojanovic B, Lazovic M, Bukva B, Radlovic V and Bumbasirevic V performed literature search and data analysis; Djordjevic ML drafted and critically revised the work.

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Correspondence to Sinisa Ducic.

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Ducic, S., Stojanovic, B., Lazovic, M. et al. T-condylar humerus fracture in children: treatment options and outcomes. International Orthopaedics (SICOT) 45, 1065–1070 (2021). https://doi.org/10.1007/s00264-020-04827-z

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