Surgical treatment of nonunion of the lateral humeral condyle in children using combined methods of bone grafting and the Ilizarov fixation

Abstract

Introduction Elbow trauma is common accounting for 40-50 % of all musculoskeletal injuries in children. From them, lateral condyle fractures are the second most common fractures in the pediatric elbow with complications ranging from 3.3 to 54.8 %.The objective was to determine the effectiveness of nonunion of the lateral humeral condyle (LHC) treated with bone grafts harvested from the patient's fibular shaft and the Ilizarov apparatus.Material and methods We report surgical treatment of bone defect repaired with bone graft and the Ilizarov apparatus in 57 children with nonunion of the LHC. Maintained articulation between the non-united bone and the radial head, magnitude and direction of displacement, visible resorption of the epimetaphysis, bone deficiency, malaligned upper limb, late ulnar neuritis were the parameters used for outcome assessment. Depending on the type of surgical treatment the patients were divided into 3 groups: Group 1 (n = 13) included patients who underwent open osteosynthesis and bone fixation using 2-3 Kirschner wires; Group 2 (n = 30) consisted of patients who underwent surgery to repair the bone defect between the humerus metaphysis and an non-united fragment of the LHC fixed with wires and immobilized with a cast; Group 3 (n = 12) included patients who were treated with bone graft followed by fixation of the bone and the graft using Ilizarov wires and frame. Two patients underwent supracondylar osteotomy.Results The outcomes were evaluated based on criteria to include non-union consolidation, joint function, limb alignment and condition of the growth plate. Long-term results were explored in 49 (85.9 %) patients out of 57 over a period of 6 months to 10 years. The results were rates as good in 39 (79.6 %) patients, as fair in 9 (18.36 %) and poor in one (2.04 %) case.Discussion Various types of operations are reported for non-united fractures and non-unions of the cervical spine to include surgeries from open osteosynthesis to complicated reconstructions.Conclusion Surgeries aimed at repair of bone defects using fibular autograft facilitated consolidation of non-unions and engraftments.