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Growth Arrest of the Capitellar Physis After Displaced Lateral Condyle Fractures in Children

Cates, Robert A. BA*; Mehlman, Charles T. DO, MPH

Journal of Pediatric Orthopaedics: December 2012 - Volume 32 - Issue 8 - p e57–e62
doi: 10.1097/BPO.0b013e31826bb0d5
Trauma-Upper Extremity

Background: Fractures of the lateral humeral condyle represent the second most common elbow fracture in children and the most common physeal fracture about the elbow. Growth disturbances after this fracture, including premature physeal arrest, are rare but important complications. Only 4 radiographically documented reports of premature physeal arrest exist to date with just 1 offering comparative views. No computed tomography (CT) evidence of this event has previously been reported in the literature. The purpose of this study is to provide well-documented radiographic evidence of premature capitellar growth arrest, substantiated by CT imaging.

Methods: We reviewed the radiographic and clinical records of 3 patients (mean age, 6.9 y) that presented with Jakob type III fractures. All fractures were treated with open reduction and internal fixation. Follow-up ranged from 1.6 to 11.1 years (mean, 6.0 y). Radiographs were evaluated for any growth disturbances, including premature capitellar-metaphyseal fusion, lateral spur formation, changes in the humeral-ulnar angles, and fishtail deformities. Contralateral elbow radiographs were utilized for comparison when available. Clinical findings at last follow-up were provided for clinical correlation.

Results: The mean time to arrest and age at arrest were 2.6 and 9.5 years, respectively. At last follow-up, patient 1 was functionally asymptomatic, showed a 6-degree increase in the humeral-ulnar angle, an increase in the carrying angle, and a fishtail deformity. Patient 2 was functionally asymptomatic, showed equal humeral-ulnar angles, and a small lateral spur formation on the injured side. Patient 3 was functionally symptomatic with pain and a 15-degree loss of extension on the injured side. There was also a 13-degree increase in the humeral-ulnar angle with an increase in carrying angle of approximately 8 degrees.

Conclusions: This is the first study to radiographically document premature physeal arrest after lateral condyle fractures using both comparative views and CT imaging. It is important for surgeons to be aware of this potential complication after lateral condyle fractures of the humerus and to diligently monitor patients annually for possible intervention until they have achieved skeletal maturity.

Level of Evidence: Level IV—case series.

*Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX

Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Investigation performed at the Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center.

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The authors declare no conflict of interest.

Reprints: Charles T. Mehlman, DO, MPH, Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229. E-mail: charles.mehlman@cchmc.org.

© 2012 Lippincott Williams & Wilkins, Inc.