Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

Hindawi Publishing Corporation The Scientific World Journal Volume 2013, Article ID 869418, 5 pages http://dx.doi.org/10.1155/2013/869418 Clinical Study Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials Véronique Andrey, Stéphane Tercier, Frédéric Vauclair, Aline Bregou-Bourgeois, Nicolas Lutz, and Pierre-Yves Zambelli Unité Pédiatrique de Chirurgie Orthopédique et Traumatologique (UPCOT), Lausanne University Hospital (CHUV), Site de l’hôpital de l’enfance, Avenue Montétan 16, 1007 Lausanne, Switzerland Correspondence should be addressed to Stéphane Tercier; Received 2 July 2013; Accepted 17 September 2013 Academic Editors: M. Inan, C.-W. Oh, and K. S. Song Copyright © 2013 Véronique Andrey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months) postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS). Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children. 1. Introduction After supracondylar fracture, distal humerus epiphyseal fracture is the second most frequent injury of the elbow in children. Epiphyseal fractures of the distal humerus are described in relation to their location. The lateral condyle is by far the more frequent. The severity of the fracture is graded from 1 to 3. A fracture without displacement is graded 1 and treated conservatively. Grades 2 and 3 represent moderate and severe displacement, respectively, and need a surgical approach [1–3]. Traditional surgical treatment consists of an open anatomical reduction, metallic Kirchner wire fixation, and cast immobilization. The metallic hardware is usually removed 6 to 8 weeks later under general anesthesia [4, 5]. In the 90s, the first bioabsorbable materials made of polyglycolic acids were used in traumatic and orthopedic surgery. Because of strong inflammatory reaction and significant clinical side effects (osteolysis, seroma formation), the use of traditional materials remained the gold standard [6, 7]. New bioabsorbable materials made of polylactic acids were introduced. They resorb slower and do not induce clinically disturbing inflammatory reactions [8]. Many orthopaedic and trauma studies confirmed the safety and efficacy of these newer bioabsorbable materials without significant side effects in adults [8–11] and with similar clinical outcome, when compared to traditional metallic materials [12–14]. In 1991, a study assessing polyglycolic bioabsorbable materials for the treatment of epiphyseal fractures of the distal humerus did not reveal significant side effects or growth disturbances after 6 months although aspecific inflammatory reactions were noticed [15–17]. The use of polylactic bioabsorbable materials did not show any bony abnormalities after one to two years, but suggested that a minimal 3 years followup was necessary to ascertain the absence of any impact on the growing bone [18, 19]. In our hospital since 2009, metallic K-wires were replaced by bioabsorbable polylactic acid materials. Since 2 polylactic materials have a significantly longer resorption time than polyglycolic materials, their impact on growing bone needed to be further assessed. The aims of this study were to demonstrate that the use of polylactic bioabsorbable materials in lateral condyle fractures of distal humerus in children did not significantly impair the growing elbow and that the functional outcome was as good as with traditional metallic materials. 2. Materials and Methods From January 2008 to December 2009, 16 children underwent surgical treatment of a lateral condyle fracture of the elbow in our pediatric orthopaedic and trauma unit. The first group (group 1) consisted of 10 children operated in 2008 using traditional metallic K-wires for fixation after open anatomical reduction. Each child required a second operation for hardware removal 6 to 8 weeks after trauma. In 2009, 6 children with similar fractures constituted group 2 and were treated using bioabsorbable pins and/or screws with the same surgical approach. Each patient was operated by the same team of senior surgeons using the following surgical technique. 2.1. Surgical Technique. The operation was performed under general anesthesia on the day of injury or the day after. In group 1, once open anatomical reduction was achieved and confirmed using fluoroscopy, fixation was secured using one or two 1.0 to 2.0 millimeter transepiphyseal metallic Kwires. Skin closure covered the wires. Postoperatively, the elbow was immobilized in a long arm cast for 1 month. The hardware was removed under general anesthesia after 6 to 8 weeks. In group 2, open anatomical reduction was temporary stabilized with metallic K-wires until final fixation with polyglycolic bioabsorbable wires and/or screws. Skin was closed after hardware removal. The bioabsorbable wires were 2.0 millimeters in diameter and had an estimated resorption time of 24 months. The elbow was also immobilized in a long arm cast for 1 month. A retrospective analysis of both functional and clinical outcomes was performed during the regular followup after 3, 6, and 12 months and more than 4 years after surgery. The functional outcome was evaluated according to the calculated Mayo Elbow Performance Score (MEPS) [20, 21]. Medical records were searched for possible clinical, operative, and postoperative complication. For the purpose of the study, AP and lateral plain radiographic studies of the fractured and contralateral healthy elbows were performed at one and four years after fracture fixation. Radiographic assessment looked for bony abnormalities such as radiolucent visible tracks, heterotopic ossifications, or bony cysts. Growth plate disturbances were recorded. When disagreement was noted among the authors’ interpretation (...truncated)