| Background and Objective:After supracondylar fracture, distal humerus epiphyseal fracture is the second most frequent injury of the elbow in children. The lateral condyle is by far the more frequent between 5-12 years. According to the fracture line extending in different directions, the fracture can be humeral lateral condyle, lateral condyle with capitellum or lateral condyle with capitellum and some epiphysis. Due to cognitional insufficient of the first doctor, it is contributing to missed diagnosis and misdiagnosis. It occurs frequently with neglected humeral lateral condylar fracture when treatment is not in time, it can led to nonunion and delayed union. Because humeral lateral condyle fracture is involved in osteoepiphysis, it would result in osteoepiphysis growth imbalance, also elbow cacogenesis such as cubitus valgus. To some extent, psychological growth of children will have a impact, and the quality of life decrease too. Neglected humeral lateral condylar fracture is difficult to treat clinically. The treatment should be managed by thinking over versatility factors including improving bone healing, diminish injury, recover joint function. From the research, we want to improve the knowledge of the disease and provide appropriate treatment to reduce the impact on the growth and function of children. Meanwhile, we followed up the results about the childrens who treated with absorbable screws fixation in our hospital, give emphasis to the impact of the growth and function of children, and provide a basis for further improvement of treatment.Methods:The clinical data of 45 cases with neglected humeral lateral condylar fracture were analyzed retrospectively from January 2012 to January 2014 in Children’s Hospital of Chongqing Medical University. There were 25 cases of male and 20 cases of female,22 cases of right and 23 cases of left, aged from 2 years to 12 years old (average,6 years old).The duration of initially trauma to surgery ranged from 21 to 80 days (average,36 days). Depending on the circumstances, patients were treated with 2 kinds of surgical treatment,18 patients were fixated with Kirschner wires,27 patients were fixated with absorbable screws. Fracture healing conditions were observed regularly. The exercise began when fractures were healing. Childrens were followed up once a-year, to know the function of elbow joint and epiphysis growth of distal humerus.Results:Totally 45 children were followed up for 6 to 24 months, with an average of 13 months. No post-operative infection, capitellum necrosis or lesions to nerves occurred. According to the outcome of Hardacre standards, excellent results were found in 11 cases (24.4%), good in 26 cases (57.8%), and poor in 8 cases (17.8%), the excellent and good rates of Kirschner wires internal fixation was 83.3%, the excellent and good rates of absorbable screws fixation was 81.5%, the total excellent and good rates was 82.2%. There is no significant difference between two fixation methods.Conclusion:It is common that cognitional insufficient of primary care doctors and irrelevant or delayed treatment are the major causes of neglected humeral lateral condylar fracture, enhance the training of primary care doctors on the children’s knowledge of specific fractures is the key to prevention. It is obviously surgery treatment of neglected humeral lateral condylar fracture can have, a satisfacted results before growth imbalance. The use of absorbable screws is a reasonable alternative to the traditional use of Kirschner wires for the treatment of lateral condyle fracture of the elbow in children. The follow-up time is short in our research, the further long-term follow-up about growth condition of elbow joint in children are needed. |
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