Osteosynthesis in situ for lateral condyle nonunion in children.
BACKGROUND
This study investigated the efficacy of osteosynthesis in situ by evaluating the functional and cosmetic results in children with nonunion of lateral condyle fractures.


METHODS
Sixteen consecutive patients were treated with in situ fixation consisting of minimal curettage of fracture gap and screw compression of metaphyseal fragments without bone grafting. The mean age at the time of surgery was 5.6 years (range, 1 to 10 y). The mean interval between the initial lateral condylar fracture and surgery was 4.8 months (range, 3 to 12 mo). The average amount of displacement measured on radiographs was 6.6 mm medially and 7.4 mm laterally. Outcome was assessed by clinical and radiologic evaluation at the latest follow-up.


RESULTS
All patients achieved bony union. The mean duration of follow-up was 45.4 months (range, 24 to 67 mo). The range of motion and flexion contracture improved postoperatively in all patients. There was no evidence of premature growth arrest, osteonecrosis, or fishtail deformity until last follow-up. The overall result was excellent in 5, good in 10, and fair in 1 patient. However, 3 patients developed valgus or varus deformities of >10 degrees.


CONCLUSIONS
Osteosynthesis in situ can be an effective and safe treatment for achieving bone union and improved elbow motion and preventing avascular necrosis. However, valgus or varus deformities may occur after this procedure and corrective osteotomy may be necessary.


METHODS
Level IV - case series.
*Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul †Department of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul ‡Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Jin-Gu, Busan, Korea.
Hoon
H
Park
Jin Ho
JH
Hwang
Yong Uk
YU
Kwon
Hyun Woo
HW
Kim
D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010020:Osteonecrosis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D000092464:Elbow Injuries