The Role Of MRI On Jakob Type ? Lateral Humeral Condyle Fractures In Children

Objective:Humerus lateral condyle fractures, which was one of the most common injury on the elbow in 5 ? 12 years old children, accounting for 16.9% of the distal humerus fractures ? There are a lot of controversy in the treatment of Jakob type I humerus lateral condyle fracture ? And the re-displacement is very likely to happen in the conservative treatment of this fracture. Once the re-displacement happened, it will be non-union to form the old humerus lateral condyle fracture and urge bone nonunion,cubitus varus, cubitus valgus, tail shape deformity, ulnar neuritis and other complications?Eventually it will become a more difficult problem. The purpose of this study was to explore the assessment of stability and the choice of treatment in children's Jakob type I lateral humeral condyle fracture by Magnetic Resonance Imaging(MRI).Methods:Thirty-nine children with Jakob type I lateral humeral condyle fractures, who were treated in our hospital from October 2015 to September 2016, underwent combined MRI and Plaster Immobilization, and their medical record materials were completed. In the results, two types of fractures were classified by the extent of the fracture line in MRI. Type A(A group), 34 cases, showed that the line coursed from the lateral metaphysis to the growth plate but not through it, and the cartilage hinge existed.In type B(B group), 5 cases, the line crossed the growth plate to enter the joint space,and the cartilage hinge had no existence. The two types which underwent plaster Immobilization, were regularly followed up by the plain radiograph. No re-displaced cases in children continued to be plaster immobilization, and the re-displaced ones,which were significantly aggravated, underwent surgical treatment. On the basis of Dhillon ratings, the healing of fractures and elbow function of children were compared.Results:In a group, no re-displaced lateral humeral condyle fractures had 33 cases, and only a re-displaced lateral humeral condyle fracture, which was significantly aggravated,underwent surgical treatment. The 2 cases did not undergo re-displacement in B group,and the other 3 cases of re-displaced lateral humeral condyle fractures aggravated significantly, underwent surgical treatment. 2.9 presents of A type could undergo re-displacement, and 60 presents of B type could undergo re-displacement.Compared to A type of fracture, the lateral humeral condyle fracture of B type with re-displacement increased significantly (P<0.01). The Prognosis of two type of fracture was 100%,but A type cases which the prognostic score is excellent are 28 cases,the rate is 82.36 presents, B type cases which the prognostic score is excellent are only 2 cases,the rate is 40 presents, the prognostic score of B Type fractures decreased obviously (P < 0.05).Conclusions:The plain radiographs are insufficient to make an accurate decision regarding the stability and the choice of treatment, MRI study distinguished the potentially unstable fracture from Jakob type I lateral humeral condyle fracture. This also provided theoretical basis for clinical treatment on Jakob type I humerus lateral condyle fracture in children.