A 6 year old girl presented to the Emergency Department after an unwitnessed fall. She was refusing to use her left arm and her left elbow was painful and swollen.
She was referred for radiography of her left elbow.Which of the following can be the most common complication in this condition?
A. Cubitus Varus
B. Cubitus Valgus
C. Ulnar Nerve Palsy
D. Myositis Ossificans
Ans:A. Cubitus Varus.
The patient in question is suffering from Fracture of lateral condyle of Humerus.
FRACTURE OF LATERAL CONDYLE OF HUMERUS
Fracture Lateral Condyle Humerus
- This is a transphyseal intraarticular injury usually involving immature skeleton of children & adolescent.
- The lateral condylar (or capitellar) epiphysis beings to ossify during the first year of life & fuses with shaft at 12-16 years. Between these ages it may be sheared off or avulsed by forceful traction. The maximum chances of injury is between 5 -15 years
- Salter Harris classified all lateral condylar physeal injuries as type IV injuries .
- Treatment guidelines follow those of type IV injury :.open reduction & internal fixation of displaced intra – articular fractures with the potential for mild growth disturbance of distal humeral physis.
- Cubitus varus/Lateral spur formation (pseudo-varus) is the most commonly reported (-40%) complication following lateral condyle fracture.
- Delayed union/ nonunion can ocur.
- The most common sequela of nonunion with displacement is the development of progressive cubitus valgus deformity. Cubitus valgus is much less common after united lateral condylar fractures than cubitus varus.
- Tardy ulnar nerve palsy is a late complication of progressive cubitus valgus deformity occuring in lateral condylar fractures.
- Growth (physial) arrest, avascular necrosis & fishtail deformity are other rare complications.