Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child
© The Author(s) 2011
Received: 5 October 2010
Accepted: 1 August 2011
Published: 31 August 2011
For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.
Fracture of the medial condyle of the humerus in a child is rare. Kilfoyle classified these fractures into three types according to the degree of displacement. He achieved favorable results with open reduction and internal fixation even in complete and displaced fractures (type 3) by diagnosing them early . Many authors have reported uniformly poor outcome for these fractures when diagnosed late and treated with open reduction and internal fixation [2–5]. We report the case of a child with nonunion of the medial condyle of the humerus with restricted and painful elbow range of motion (ROM) and cubitus varus deformity who was treated successfully with open reduction and internal fixation.
Fracture of the medial condyle of the humerus is a rare injury in children, comprising 1–2% of all pediatric elbow fractures [2, 5, 6, 8]. Diagnosing such fractures radiologically can be difficult in younger children because the fracture is primarily through the cartilage, and the trochlea is not completely ossified until around the age of 9 years [2, 6, 7]. Pain, swelling, ecchymosis over the medial elbow, and radiographic findings of “a few radiodensities” far medial to the elbow are important diagnostic clues to this fracture. If this constellation of signs and symptoms is seen, other diagnostic modalities, such as MRI, ultrasonograph, arthrogram, and computed tomography are indicated. Several researchers have reported a high risk of avascular necrosis in surgical treatment of nonunion medial condylar fractures because takedown of the forearm flexor is required to expose the fracture site [1–3]. Better functional results are achieved by accepting a nonunion than by the acquired avascular necrosis . Corrective supracondylar osteotomy has been considered a preferred alternative to open reduction and internal fixation of the nonunited fragment to correct the deformity and improve elbow ROM in patients in whom the fracture is discovered late . We had favorable results with open reduction and internal fixation, with no serious complications. Although it is difficult to draw conclusions from one case only, we believe that leaving the flexor muscle attached to the fracture fragment is important to prevent trochlea avascular necrosis. As medial condyle fractures are intra-articular Salter Harris type IV injuries, early diagnosis is extremely important to obtain good result without serious complications [2, 7, 9]. Therefore, if there is clinical suspicion of medial condyle fracture, the patient must be further evaluated for early fracture detection.
Conflict of interest
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