Session V Pediatrics

T-Condylar Fractures of The Distal Humerus in the Young

Paul R. Re, MD, Peter M.Waters, MD, M. Timothy Hresko, MD

The Children's Hospital, Boston, MA

Purpose: The T-Y condylar fracture of the distal humerus is a rare occurrence in children and adolescents. The purpose of this study is to further define this fracture, its presentation and treatment in this age group. In cases in which open reduction and internal fixation (ORIF) was required, the following questions were also addressed; how does surgical approach, intra-articular damage and the use of continuous passive motion (CPM) effect final range of motion.

Conclusion: Fifteen patients required a surgical procedure for significant displacement of intra-articular fracture fragments. The posterior-medial (Bryan-Morrey) and the olecranon osteotomy approach resulted in a statistically significant better extension than the triceps splitting approach. Patients with articular damage had statistically significant less extension at follow-up. The use of CPM in the immediate post-operative period resulted in a functional range of motion sooner and yielded a statistically significant increase in flexion at follow-up examination than when not employed.

Materials & Method: This is a retrospective review of seventeen T-condylar fractures in children and adolescents treated at The Children's Hospital in Boston Massachusetts, from 1989 to 1995. Fifteen of these required ORIF. Mean average postoperative follow-up was 16 months (range 6 months to 3 years).

Results: Five of the patients were female and twelve were male. The age range was from nine to sixteen year olds with an average age of thirteen. The large majority of patients suffered their fractures as a result of a fall. Twice as many patients injured their left distal humerus. Two and a half as many patients injured their non-dominant distal humerus. Five patients presented with a neuropathy (four ulnar and one radial), all of which spontaneously resolved. Sixteen of the fractures were closed injuries, and one was an open grade I injury AO type C3. AO fracture classification; type C1:6; type C2:7; C3:4. Fifteen patients required a surgical procedure. Surgical approaches used; triceps splitting: 4 patients; olecranon osteotomy: 4 patients; posterior-medial: 6 patients. The posterior-medial and the olecranon osteotomy approach resulted in a statistically significant better extension than the triceps splitting. Also, the triceps splitting approach yielded less mean flexion. There was no statistical significance noted in final range of motion outcome based on fracture classification. However when intra-articular damage was observed, there was a statistically significant less mean extension and a trend toward less mean flexion. Eight patients were started on CPM within two days post-operatively, while seven patients were splinted or casted for four or more weeks. Patients who used CPM regained a more functional elbow range of motion sooner than, and had a significant better flexion than the patients who were immobilized.