T-condylar humerus fracture in children: treatment options and outcomes
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REVIEW ARTICLE
T-condylar humerus fracture in children: treatment options and outcomes Sinisa Ducic 1 & Borko Stojanovic 1 & Mikan Lazovic 1 & Bojan Bukva 1 & Vladimir Radlovic 1 & Vojislav Bumbasirevic 1 & Miroslav L. Djordjevic 1 Received: 7 September 2020 / Accepted: 22 September 2020 # SICOT aisbl 2020
Abstract Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns. Keywords Fracture . Distal humerus . T-condylar fracture . Open reduction . Range of motion
Introduction The T-type distal humerus fracture is very rare in the paediatric population compared with adolescents. Real incidence is still unknown since the published papers mostly present case reports or case series [1, 2]. A paediatric T-condylar humerus fracture can sometimes be mistaken for an extension supracondylar humeral fracture. The difference is that the fracture line in T-type extends into the intercondylar region of the distal humerus, so high quality radiographs are necessary for proper initial diagnosis and adequate management [3]. Two classifications are frequently used for fracture description. Toniolo and Wilkins defined three types of intercondylar fractures: minimally displaced fracture (type I), displaced but not comminuted fracture (type II) and displaced and comminuted
* Sinisa Ducic [email protected] 1
School of Medicine, University of Belgrade, Belgrade 11000, Serbia
fracture (type III) [4]. According to the Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA), there are also three types: intercondylar fracture without comminution (C1 fracture), split condyles with supracondylar comminution (C2 fracture) and sp
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