Session V - Pediatrics

Fri., 10/6/06 Pediatrics & Spine, Paper #26, 11:12 am

Evaluation of Fracture Type and Surgical Method as Predictors of Postoperative Improvements in Pain, Range of Motion, and Bony Healing of T-Condylar Distal Humerus Fractures in Children

Jaimo Ahn, MD, PhD (n); Jeffrey F. Sodl, MD (n);
John M. Flynn, MD (n); Theodore J. Ganley, MD (n);
Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA

Purpose: Outcomes of T-condylar fractures of the distal humerus in children are not well described in the orthopaedic literature. We examined the relationship between fracture type, operative method, and time to reaching several clinical milestones.

Methods: We identified 22 consecutive patients treated for T-condylar fractures of the distal humerus. Ten of these patients continued care at our institution. Eight (two had only short follow-up) were further divided into cohorts and analyzed for differences in clinical outcomes.

Results: The 10 patients had a mean age of 12 years (range, 5-15) at the time of injury and sustained five OTA C1, three C2, and two C3 type fractures with no primary neurovascular deficits. Postoperatively, the mean time to (1) fracture healing was 12.6 weeks (range, 6-23), (2) absence of pain was 12.0 weeks (range, 1-42) and (3) maximum range of motion was 34.8 weeks (rang,e 6-83). Five patients returned to the operating room for removal of hardware or manipulation at a mean of 42 weeks (range, 11-79). The complication rate was 40% and included transient sensory deficit, superficial infection, arthrofibrosis, and return of pain (range, 1-145). There was no statistical difference in time to resolution of postoperative pain based on OTA fracture type, surgical approach, or fixation method (P >0.05). Mean fracture healing time was 7 weeks less for those patients treated via olecranon osteotomy (P <0.05) and 3 weeks less for those fixed with 90-90 plating (P >0.05). Patients with C2/3 fractures (compared to C1), olecranon osteotomy, and 90-90 plating had a shorter mean time to maximum elbow range of motion by 10 (P >0.05),16, and 18 (P <0.05) weeks, respectively. Patients with all three factors had a mean return that was 23 weeks faster than those without all three factors (P <0.05).

Conclusion/Significance: T-condylar distal humerus fractures in children require high vigilance due to a high complication rate; need for secondary procedures; and unpredictable times (large ranges) to healing, resolution of pain, and attainment of maximum range of motion. The fracture pattern, surgical approach, and fixation methods (especially in combination) can be predictors of outcomes. Because prospective studies on this rare injury are difficult, the accumulation of small retrospective cohorts may provide the most practical path to optimizing treatment.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.