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O Leonidou - One of the best experts on this subject based on the ideXlab platform.
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Open reduction internal fixation of lateral Humeral Condyle fractures in children. A series of 105 fractures from a single institution
Strategies in Trauma and Limb Reconstruction, 2014Co-Authors: Andreas Leonidou, K Antonis, Eleftherios Tsiridis, Krissen Chettiar, Simon Graham, Pouya Akhbari, O LeonidouAbstract:Lateral Humeral Condyle fractures account for 17 % of the distal Humeral Condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral Humeral Condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF of lateral Humeral Condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral Condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob’s classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral Condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV.
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open reduction internal fixation of lateral Humeral Condyle in children a series of 105 fractures from a single institution
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: J Pagkalos, Andreas Leonidou, P Lepetsos, K Antonis, I Flieger, Eleftherios Tsiridis, O LeonidouAbstract:Introduction Lateral Humeral Condyle fractures account for 17% of the distal Humeral Condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures. Methods We retrospectively reviewed children treated with open reduction internal fixation of these fractures at a single institution over a period of 13 years. All cases of lateral Humeral Condyle fractures treated with ORIF were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and clinical examination at latest follow up were reviewed. Results 105 lateral Condyle fractures were identified. 76 (72%) in boys and 29 (28%) in girls. Average age was 6.2 years. 92 were Milch type 2 and 13 Milch type 1. According to the Jacobs classification for displacement 9 were type I, 33 Type II and 63 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to union (radiologic) was 34 days. Mean follow up was 39 months. Hypertrophy of the lateral Condyle in follow up radiographs was documented in 45 cases (42%). Cubitus Varus was documented in 7 cases (7%). None of the children complained of painful range of movement at latest follow up. There was one case of superficial infection of the K-wires and one case of delayed union. Discussion Open reduction internal fixation is the established management of lateral Humeral Condyle fractures. This series confirms the consistently good results of open reduction. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique.
Satoshi Toh - One of the best experts on this subject based on the ideXlab platform.
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long standing nonunion of fractures of the lateral Humeral Condyle
Journal of Bone and Joint Surgery American Volume, 2002Co-Authors: Satoshi Toh, Kenji Tsubo, Shinji Nishikawa, Sadahiro Inoue, Ryuujiro Nakamura, Seiko HarataAbstract:Background: Patients with nonunion of a fracture of the lateral Humeral Condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral Humeral Condyle to correlate the clinical long-term outcome of this condition with the original fracture type. Methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. Patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. Results: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60° to 145°; average, 99°) was more restricted than that in Group 2 (range, 100° to 150°; average, 129°) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). Conclusion: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.
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Long-standing nonunion of fractures of the lateral Humeral Condyle.
The Journal of bone and joint surgery. American volume, 2002Co-Authors: Satoshi Toh, Kenji Tsubo, Shinji Nishikawa, Sadahiro Inoue, Ryuujiro Nakamura, Seiko HarataAbstract:Patients with nonunion of a fracture of the lateral Humeral Condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral Humeral Condyle to correlate the clinical long-term outcome of this condition with the original fracture type. Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. Patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60 degrees to 145 degrees; average, 99 degrees) was more restricted than that in Group 2 (range, 100 degrees to 150 degrees; average, 129 degrees) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.
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Osteosynthesis for nonunion of the lateral Humeral Condyle.
Clinical orthopaedics and related research, 2002Co-Authors: Satoshi Toh, Kenji Tsubo, Shinji Nishikawa, Sadahiro Inoue, Ryuujiro Nakamura, Shunsuke NaritaAbstract:The treatment of established nonunion of the lateral Humeral Condyle is controversial. Twenty patients who had osteosynthesis of the nonunion were evaluated to clarify the changes in range of motion and the factors influencing those changes. The average age of the patients at surgery was 13.6 years (range, 6-25 years). The average duration of followup was 8.8 years. Outcome was rated as excellent in seven patients and good in 13 patients according to the score of Broberg and Morrey. In five of the 20 patients, the preoperative range of motion was limited and their motion improved an average of 35 degrees as a result of surgery. In the remaining 15 patients, the range of motion did not change or was reduced an average of 19 degrees postoperatively. Of the 15 patients, 11 had Milch Type II injuries and four had Milch Type I injuries. In the 11 patients with Milch Type II injuries, the loss of range of motion postoperatively averaged 13 degrees. However, in the four patients with Milch Type I injuries, loss of range of motion postoperatively averaged 21 degrees. Complications such as delayed union, nonunion, or infection occurred in five patients. The main factors influencing the results of osteosynthesis are the age of the patient, the preoperative symptoms, and the postoperative complications.
Seiko Harata - One of the best experts on this subject based on the ideXlab platform.
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long standing nonunion of fractures of the lateral Humeral Condyle
Journal of Bone and Joint Surgery American Volume, 2002Co-Authors: Satoshi Toh, Kenji Tsubo, Shinji Nishikawa, Sadahiro Inoue, Ryuujiro Nakamura, Seiko HarataAbstract:Background: Patients with nonunion of a fracture of the lateral Humeral Condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral Humeral Condyle to correlate the clinical long-term outcome of this condition with the original fracture type. Methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. Patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. Results: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60° to 145°; average, 99°) was more restricted than that in Group 2 (range, 100° to 150°; average, 129°) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). Conclusion: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.
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Long-standing nonunion of fractures of the lateral Humeral Condyle.
The Journal of bone and joint surgery. American volume, 2002Co-Authors: Satoshi Toh, Kenji Tsubo, Shinji Nishikawa, Sadahiro Inoue, Ryuujiro Nakamura, Seiko HarataAbstract:Patients with nonunion of a fracture of the lateral Humeral Condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral Humeral Condyle to correlate the clinical long-term outcome of this condition with the original fracture type. Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. Patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60 degrees to 145 degrees; average, 99 degrees) was more restricted than that in Group 2 (range, 100 degrees to 150 degrees; average, 129 degrees) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.
William J. Hornof - One of the best experts on this subject based on the ideXlab platform.
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incomplete ossification of the Humeral Condyle in vietnamese pot bellied pigs
Veterinary Radiology & Ultrasound, 2000Co-Authors: Valerie F. Samii, William J. HornofAbstract:The purpose of this study was to evaluate the occurrence of Humeral condylar fractures in Vietnamese pot-bellied pigs and to postulate a possible predisposing cause for these fractures. Thirteen Vietnamese pot-bellied pigs (Group A) were evaluated over an eight year period (1990–1998), each with a history of either a unilateral or bilateral forelimb lameness. The cause of lameness was localized to the elbow region. Of the thirteen pigs, twenty-one elbows were evaluated radiographically. Pigs ranged in age from six months to four years old. All pigs over the age of seven months showed radiographic evidence of elbow degenerative joint disease. Fractures involving the medial aspect of the Humeral Condyle were identified in 8/21 studies (38%). A well-defined linear intracondylar articular lucency was identified in 7/21 studies (33%) on the craniocaudal projection. The site of this lucency corresponded to the location of the articular component of the fractures seen involving the Humeral Condyle. The elbows of five pot-bellied pigs with no known history of forelimb lameness or trauma (Group B) were evaluated radiographically following euthanasia. All five pigs were of unknown age and gender. An intracondylar vertical linear lucency was identified bilaterally in three pigs (60%). Concurrent degenerative joint disease was present in all instances. The remaining two pigs were radiographically normal. Computed tomography of the elbows was performed in one affected pig front Group B. The radiographic findings in this pig were verified. Histopathology of the right elbow of this affected pig was diagnostic for incomplete endochondral ossification of the Humeral Condyle. A similar condition involving the Humeral Condyle has been previously described in Cocker and Brittany Spaniels. These canine breeds also have a high incidence of Humeral condylar fractures. It is postulated that Vietnamese pot-bellied pigs are similarly prone to Humeral condylar fractures, even in the absence of known trauma, due to incomplete ossification of the Humeral Condyle.
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INCOMPLETE OSSIFICATION OF THE Humeral Condyle IN VIETNAMESE POT‐BELLIED PIGS
Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology As, 2000Co-Authors: Valerie F. Samii, William J. HornofAbstract:The purpose of this study was to evaluate the occurrence of Humeral condylar fractures in Vietnamese pot-bellied pigs and to postulate a possible predisposing cause for these fractures. Thirteen Vietnamese pot-bellied pigs (Group A) were evaluated over an eight year period (1990–1998), each with a history of either a unilateral or bilateral forelimb lameness. The cause of lameness was localized to the elbow region. Of the thirteen pigs, twenty-one elbows were evaluated radiographically. Pigs ranged in age from six months to four years old. All pigs over the age of seven months showed radiographic evidence of elbow degenerative joint disease. Fractures involving the medial aspect of the Humeral Condyle were identified in 8/21 studies (38%). A well-defined linear intracondylar articular lucency was identified in 7/21 studies (33%) on the craniocaudal projection. The site of this lucency corresponded to the location of the articular component of the fractures seen involving the Humeral Condyle. The elbows of five pot-bellied pigs with no known history of forelimb lameness or trauma (Group B) were evaluated radiographically following euthanasia. All five pigs were of unknown age and gender. An intracondylar vertical linear lucency was identified bilaterally in three pigs (60%). Concurrent degenerative joint disease was present in all instances. The remaining two pigs were radiographically normal. Computed tomography of the elbows was performed in one affected pig front Group B. The radiographic findings in this pig were verified. Histopathology of the right elbow of this affected pig was diagnostic for incomplete endochondral ossification of the Humeral Condyle. A similar condition involving the Humeral Condyle has been previously described in Cocker and Brittany Spaniels. These canine breeds also have a high incidence of Humeral condylar fractures. It is postulated that Vietnamese pot-bellied pigs are similarly prone to Humeral condylar fractures, even in the absence of known trauma, due to incomplete ossification of the Humeral Condyle.
Hideki Yoshikawa - One of the best experts on this subject based on the ideXlab platform.
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three dimensional in vivo kinematics during elbow flexion in patients with lateral Humeral Condyle nonunion by an image matching technique
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Akira Goto, Tsuyoshi Murase, Kazuomi Sugamoto, Hisao Moritomo, Kunihiro Oka, Hideki YoshikawaAbstract:Background An established nonunion of the lateral Humeral Condyle often reveals elbow instability and accompanying pain. The purpose of this study was to obtain 3-dimensional and quantitative information about the pathologic kinematics of the ulnoHumeral joint with nonunion of the lateral Humeral Condyle by an in vivo and 3-dimensional motion analysis. Methods Magnetic resonance or computed tomography images of the elbows of 14 patients were acquired in 3 positions between full extension and full flexion. We evaluated ulnoHumeral motion and calculated the change in the length of the medial collateral ligament during elbow flexion. Results UlnoHumeral motion was associated with an excessive lateral shift of ulnar movement. In addition, the distal part of the ulna was rotated in the varus direction, leading to a decrease in the carrying angle. The ulna tended to exhibit internal rotation from full extension to 90° of flexion of the elbow. With further flexion, the ulna rotated externally and returned to its neutral position. Furthermore, the length of the medial collateral ligament increased with an increase in the elbow flexion angle. Conclusion Patients with lateral Humeral Condyle nonunion showed excessive lateral shift of the ulna and ulnar axial rotation. Also, the lateral shift caused an osseous protrusion of the medial trochlea, leading to elongation of the medial collateral ligament.
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Three-dimensional in vivo kinematics during elbow flexion in patients with lateral Humeral Condyle nonunion by an image-matching technique
Journal of shoulder and elbow surgery, 2014Co-Authors: Akira Goto, Tsuyoshi Murase, Kazuomi Sugamoto, Hisao Moritomo, Kunihiro Oka, Hideki YoshikawaAbstract:An established nonunion of the lateral Humeral Condyle often reveals elbow instability and accompanying pain. The purpose of this study was to obtain 3-dimensional and quantitative information about the pathologic kinematics of the ulnoHumeral joint with nonunion of the lateral Humeral Condyle by an in vivo and 3-dimensional motion analysis. Magnetic resonance or computed tomography images of the elbows of 14 patients were acquired in 3 positions between full extension and full flexion. We evaluated ulnoHumeral motion and calculated the change in the length of the medial collateral ligament during elbow flexion. UlnoHumeral motion was associated with an excessive lateral shift of ulnar movement. In addition, the distal part of the ulna was rotated in the varus direction, leading to a decrease in the carrying angle. The ulna tended to exhibit internal rotation from full extension to 90° of flexion of the elbow. With further flexion, the ulna rotated externally and returned to its neutral position. Furthermore, the length of the medial collateral ligament increased with an increase in the elbow flexion angle. Patients with lateral Humeral Condyle nonunion showed excessive lateral shift of the ulna and ulnar axial rotation. Also, the lateral shift caused an osseous protrusion of the medial trochlea, leading to elongation of the medial collateral ligament. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.