Tri Continental Pediatric Orthopedic Surgery Symposium Sao Paulo Brazil October 1114 2017 Perry L Schoenecker MD St Louis Shriners St Louis Childrens amp Barnes Hospitals Washington University School of Medicine ID: 775461
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5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery SymposiumSao Paulo, BrazilOctober 11-14, 2017
Perry L. Schoenecker, M.D.St. Louis Shriners, St. Louis Children’s & Barnes Hospitals, Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA
Lateral Condylar Fractures
Slide2Lateral Condylar Fractures
Perry L. Schoenecker, M.D.
No Conflicts, No Disclosures
Jacob I
Slide3Lateral Condyle Fractures
~15 % of all elbow fractures
Slide4Lateral Condyle Fractures
~15 % of all elbow fractures
Second to Supracondylar
Slide5Mechanism – Pull Off
Slide6Varus Pronation Distraction
Distraction
Pull Off
Slide7Varus Pronation Distraction
Pull Off
Slide8Classification
SONG
JACOB
JBJS
57B
, 1975
Slide9Classification
SONG
JBJS (A) 90, 2008
JACOB
JBJS
57B
, 1975
Slide10Jacob I
SONG
1
2
3
5
4
< 2mm
Slide11Immobilize ≥ 4weeks
→ F/U until healed
Jacob I
< 2mm
Minimal Displacement
Slide12Displacement ~ 2mm
Medial Oblique
Slide13Jacob I
SONG
1
2
3
5
4
Tx
options: long arm cast or reduction, pinning & cast
Slide14Closed
reduction
and k-wire stabilization
Slide15Jacob II
Closed reduction pinning and
arthrogram
2-4mm
Slide16“Notable Displacement”
Scheduled for open reduction
Slide17Very stable in
OR, so
closed reduction & k-wire fixation
Arthrogram shows condylar surface reduced
Slide18Post
pinning w/o a satisfactory reduction
MUST ANATOMICALLY Reduce
Notably displaced
Slide19Completely Displaced
Jacob III
Slide20Anatomically reduce & stabilize
Slide21Lateral Condylar Fxs - Surgical Approach
– Dissect anteriorly - not posteriorly
– Curved mid-lateral 5-6cm
Yes
No
Slide22Stage III Lateral Condyle Fx --- ORIF
Headlight
Treatment
Tourniquet
Slide23Exposure
Reduction/Fixation
Treatment
Stage III
Lateral Condyle Fx --- ORIF
Slide24Stage III Fx --- ORIF
Treatment
Anatomically
reduce
Stabilize
Stabilize
Slide25Verify Reduction
Stabilize
Stage III Fx --- ORIF
Slide26Stage III Fx --- ORIF
Slide273 pins
may be necessary
Stage III Fx --- ORIF
Slide28Painful Delayed Union
Healing may be slow to occur
s/p 8 wks of cast
Slide29Delayed / Non Union
Needs reduction and compression
Slide30Slide314
mos post ORIF painful
Compression/stability
Delayed/non-union
stabilize as is
Slide32Lat Condylar FXs – Take Home Message
Follow-up until HEALED Slight displacement → CR, a’gram & pin
• Displacement &/or instability → ORIF (must SEE THE JOINT)
Delayed/non-union
→ STABILIZE typically as is
Slide33Obrigado
--------------
Thank
you
Slide34Minimal Displacement
Immobilize ≥ 4weeks
→ F/U until healed
~ 2mm