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

*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.
Journal of pediatric orthopedics (Impact Factor: 1.47). 12/2012; 32(8):e57-62. DOI: 10.1097/BPO.0b013e31826bb0d5
Source: PubMed


: 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.
: 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.
: 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.
: 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 IV-case series.

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    ABSTRACT: A systematic review regarding clinical studies on Hegemann's disease and fishtail deformity was performed with the aims to: (1) formulate the most up-to-date theory on aetiology in order to better define these conditions, (2) summarise the most frequent radiographic descriptions on radiographs and (3) give an overview of different treatment options. A systematic review of studies to date on Hegemann's disease and fishtail deformity was performed. Studies were eligible if: (1) the article provides a description of Hegemann's disease or fishtail deformity, (2) original data of at least one patient was available, (3) the article was written in English, German or Dutch and (4) a full manuscript was available. Animal studies, reviews and expert opinions were not included. We included a total of 22 articles: seven regarding Hegemann's disease including eight patients and 15 regarding fishtail deformity including 58 patients. Fishtail deformity and Hegemann's disease seem to be a spectrum of vascular disorders of the distal humerus, varying from a benign mild vascular disorder to a complete avascular necrosis after fractures. Additional imaging is advised to confirm the presence of a fishtail deformity, intra-articular loose bodies and signs of osteoarthritis to decide if, and what, operative treatment is needed. As long as no clear aetiology for both diseases exist and the clinical symptoms and radiographic appearance are difficult to distinguish, both entities should preferably be named as 'vascular disturbance of the trochlear growth plate' to overcome confusing definitions and discussions.
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