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Lateral Condylar Fractures
5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery Symposium Sao Paulo, Brazil October 11-14, 2017 Lateral Condylar Fractures Perry L. Schoenecker, M.D. St. Louis Shriners, St. Louis Children’s & Barnes Hospitals, Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA
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Lateral Condylar Fractures No Conflicts, No Disclosures
Jacob I Perry L. Schoenecker, M.D. No Conflicts, No Disclosures
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Lateral Condyle Fractures
~15 % of all elbow fractures
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Lateral Condyle Fractures
~15 % of all elbow fractures Second to Supracondylar
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Mechanism – Pull Off
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Varus Pronation Distraction
Pull Off
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Varus Pronation Distraction
Pull Off
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Classification JACOB JBJS 57B, 1975 SONG
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Classification JACOB JBJS 57B, 1975 SONG JBJS (A) 90, 2008
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Jacob I < 2mm 1 2 3 4 5 SONG
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Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement Jacob I < 2mm Immobilize ≥ 4weeks → F/U until healed
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Displacement ~ 2mm Medial Oblique
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Tx options: long arm cast or reduction, pinning & cast
Jacob I 1 4 5 2 3 SONG Tx options: long arm cast or reduction, pinning & cast
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Closed reduction and k-wire stabilization
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Closed reduction pinning and arthrogram
Jacob II 2-4mm Closed reduction pinning and arthrogram Tanane, elias
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“Notable Displacement” Scheduled for open reduction
Casey, Adrianne A’gram, stable, type II, CR “Notable Displacement” Scheduled for open reduction
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Very stable in OR, so closed reduction & k-wire fixation
Arthrogram shows condylar surface reduced Casey, Adrianne A’gram, stable, type II, CR
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MUST ANATOMICALLY Reduce
Notably displaced Post pinning w/o a satisfactory reduction 𝑩𝑨𝑫 𝑰𝑫𝑬𝑨, 𝐧𝐨𝐰 𝐩𝐫𝐨𝐛𝐥𝐞𝐦𝐚𝐭𝐢𝐜 𝐧𝐨𝐧 𝐮𝐧𝐢𝐨𝐧
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Completely Displaced Jacob III
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Anatomically reduce & stabilize
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Lateral Condylar Fxs - Surgical Approach
– Curved mid-lateral 5-6cm – Dissect anteriorly - not posteriorly Yes No
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Stage III Lateral Condyle Fx --- ORIF
Treatment Stage III Lateral Condyle Fx --- ORIF Headlight Tourniquet
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Stage III Lateral Condyle Fx --- ORIF
Treatment Stage III Lateral Condyle Fx --- ORIF Exposure Reduction/Fixation
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Stage III Fx --- ORIF Stabilize Stabilize Anatomically reduce
Treatment Stage III Fx --- ORIF Stabilize Stabilize Anatomically reduce
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Stage III Fx --- ORIF Stabilize Verify Reduction
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Stage III Fx --- ORIF
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Stage III Fx --- ORIF 3 pins may be necessary
Scott, Cassie Lateral condylar stage , ORIF R lateral condylar fx
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Healing may be slow to occur
s/p 8 wks of cast Painful Delayed Union
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Delayed / Non Union Needs reduction and compression
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Compression/stability Delayed/non-union stabilize as is
4 mos post ORIF painful Compression/stability Philpot, jacob Delayed/non-union stabilize as is
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Lat Condylar FXs – Take Home Message
Follow-up until HEALED Slight displacement → CR, a’gram & pin • Displacement &/or instability → ORIF (must SEE THE JOINT) Delayed/non-union → STABILIZE typically as is
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Obrigado Thank you
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Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement ~ 2mm Immobilize ≥ 4weeks → F/U until healed
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