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Characteristics of Elbow Deformity After Mild Lateral Humeral Condylar Fracture
Takehiko Takagi, MD, PhD1; Atsuhito Seki, MD, PhD2; Shinichiro Takayama, MD, PhD2; Yuka Kobayashi, MD, PhD1; Joji Mochida, MD, PhD1
1University School of Medicine, Isehara, Kanagawa, Japan; 2National Center for Child Health and Development, Tokyo, Japan

Introduction: Lateral humeral condylar fractures heal with some residual elbow deformity, e.g., fishtail deformity, cubitus varus/valgus deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. We hypothesized some angulation about cubitus varus as well as fishtail deformity at the distal end of humerus was arisen after the lateral condylar fractures.

Materials & Methods: Between 2005 and 2015, we treated 107 mild (Wadsworth types I and II) fractures of the lateral humeral condyle. 23 fractures were treated by open reduction and internal fixation (ORIF) with K-wires. 84 cases were treated with a long arm splint for 3 weeks. There were 81 male and 26 female patients. The average age of the patients at the time of the injury was 6.0 years (range, 2 to 11 years). The average follow-up period was 22.5 months (range, 7 to 62 months). The humerus-elbow-wrist angle (HEWA; angle between long axis of humeral shaft and midline of the forearm bones), Baumann's angle (BA; angle between long axis of humeral shaft and growth plate of lateral condyle on AP view), tilting angle (TA; angle between long axis of humeral shaft and axis of lateral condyle on lateral view), fishtail deformity were evaluated on the radiographs. The active ranges of motion (ROM) were clinically assessed at unaffected and affected sides at the final follow-up.

Results: No significant difference was detected between the sides in regard to BA, TA, or ROM at the final follow-up. However, HEWA showed more significant loss of correction (p = 0.021). There was 2.2 degrees at the affected side compared with 8.4 degrees at the unaffected side. Fishtail deformity was shown in 7 out of 107 cases. There were significant differences in HEWA or fishtail deformity at affected side between ORIF and splint groups.

Conclusions: Mild lateral humeral condylar fractures followed subclinical cubitus varus or fishtail deformity. There were significant lower HEWAs after the fractures. ORIF does not prevent the deformities. Overgrowths at the site of fracture can be developed at both of ORIF and splint groups. BA, TA, or ROM was not significantly changed compared with that at unaffected side. In summary, cubitus varus deformity after lateral humeral condylar fracture is not accompanied by a change of TA or BA, unlike the deformity after supracondylar or distal epiphyseal fracture of the humerus.

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