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Lateral Condylar Fractures

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Presentation on theme: "Lateral Condylar Fractures"— Presentation transcript:

1 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

2 Lateral Condylar Fractures No Conflicts, No Disclosures
Jacob I Perry L. Schoenecker, M.D. No Conflicts, No Disclosures

3 Lateral Condyle Fractures
~15 % of all elbow fractures

4 Lateral Condyle Fractures
~15 % of all elbow fractures Second to Supracondylar

5 Mechanism – Pull Off

6 Varus Pronation Distraction
Pull Off

7 Varus Pronation Distraction
Pull Off

8 Classification JACOB JBJS 57B, 1975 SONG

9 Classification JACOB JBJS 57B, 1975 SONG JBJS (A) 90, 2008

10 Jacob I < 2mm 1 2 3 4 5 SONG

11 Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement Jacob I < 2mm Immobilize ≥ 4weeks → F/U until healed

12 Displacement ~ 2mm Medial Oblique

13 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

14 Closed reduction and k-wire stabilization

15 Closed reduction pinning and arthrogram
Jacob II 2-4mm Closed reduction pinning and arthrogram Tanane, elias

16 “Notable Displacement” Scheduled for open reduction
Casey, Adrianne A’gram, stable, type II, CR “Notable Displacement” Scheduled for open reduction

17 Very stable in OR, so closed reduction & k-wire fixation
Arthrogram shows condylar surface reduced Casey, Adrianne A’gram, stable, type II, CR

18 MUST ANATOMICALLY Reduce
Notably displaced Post pinning w/o a satisfactory reduction  𝑩𝑨𝑫 𝑰𝑫𝑬𝑨, 𝐧𝐨𝐰 𝐩𝐫𝐨𝐛𝐥𝐞𝐦𝐚𝐭𝐢𝐜 𝐧𝐨𝐧 𝐮𝐧𝐢𝐨𝐧

19 Completely Displaced Jacob III

20 Anatomically reduce & stabilize

21 Lateral Condylar Fxs - Surgical Approach
– Curved mid-lateral 5-6cm – Dissect anteriorly - not posteriorly Yes No

22 Stage III Lateral Condyle Fx --- ORIF
Treatment Stage III Lateral Condyle Fx --- ORIF Headlight Tourniquet

23 Stage III Lateral Condyle Fx --- ORIF
Treatment Stage III Lateral Condyle Fx --- ORIF Exposure Reduction/Fixation

24 Stage III Fx --- ORIF Stabilize Stabilize Anatomically reduce
Treatment Stage III Fx --- ORIF Stabilize Stabilize Anatomically reduce

25 Stage III Fx --- ORIF Stabilize Verify Reduction

26 Stage III Fx --- ORIF

27 Stage III Fx --- ORIF 3 pins may be necessary
Scott, Cassie Lateral condylar stage , ORIF R lateral condylar fx

28 Healing may be slow to occur
s/p 8 wks of cast Painful Delayed Union

29 Delayed / Non Union  Needs reduction and compression

30

31 Compression/stability Delayed/non-union  stabilize as is
4 mos post ORIF painful Compression/stability Philpot, jacob Delayed/non-union  stabilize as is

32 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

33 Obrigado Thank you

34 Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement ~ 2mm Immobilize ≥ 4weeks → F/U until healed


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