Morphometric Study Of Upper End Of Tibia : A Study Done At Skims Medical College Srinagar

Introduction:Upper end of tibia is an important component of knee joint. The aim of present study is to analyse different morphometric parameters of condylar and intercondylar surface of tibia, so as to formulate a baseline data for future studies with relevance to Indian population and to compare the current data with previous literature. Morphometric study of upper end of tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Material and Method: 30 dried human adult tibia were obtained from Dept. of anatomy SKIMS Medical College bemina Srinagar. Morphometric measurements of medial condyle, lateral condyle and intercondylar area of tibiae were measured with Vernier caliper.Result: Anteroposterior measurements were found to be greater than transverse measurements for both medial and lateral condyles. Furthermore, both anteroposterior and transverse measurements were greater in medial condyle than in lateral condyle.Racial differences were observed.Conclusion:The present study is to provide a base line data pertaining to morphometric details of upper end of tibia in Indian population, which aims to provide help for anatomists, anthropologists, and orthopedics, in knee arthroplasty procedures, and meniscal transplantation

Morphometric analysis of tibial plateau

Background: Arthritis and injuries of the knee are frequently managed by knee arthroplasty. Knee prosthesis thus used needs population specific appropriate sizing. The aim of the study is to analyse tibial plateau morphometrically.Methods: The study included 46 human tibia bones (28 left and 18 right). The anteroposterior length and transverse width of superior articular surface of both tibial condyles along with the anteroposterior length and transverse measurements of the intercondylar area were noted with digital Vernier caliper. The data was tabulated and analysed.Results: For the superior articular surface of medial condyle, anteroposterior length was found to be 4.12±0.42cm on left side and 4.17±0.50cm on right side; maximum width was found to be 2.81±0.59cm on left side and 2.78±0.34cm on right side. For the superior surface of lateral condyle, the anteroposterior length was found to be 3.92±0.30cm on left side and 3.66±0.31cm on right side whereas maximum width was found to be 3.12±0.68cm on left side and 2.87±0.55cm on right side. Anteroposterior length of intercondylar area was measured to be 4.31±0.40cm on left side and 4.18±0.44cm on right side. The transverse measurement was recorded to be 3.12±0.68cm (left side), 2.87±0.55cm (right side) anteriorly; 1.25±0.23cm (left side), 1.31±0.20cm (right side) in the middle and 1.28±0.39cm (left side), 1.85±0.42cm (right side) posteriorly.Conclusions: The results will be helpful in orthopaedic surgical procedures involving knee.

Delayed Operative Management of Fractures of the Lateral Condyle of the Humerus in Children

Purpose; Delayed presentation of lateral condylar fractures of the humerus is relatively common in the developing regions of the world. These fractures are difficult to manage because of the displacement and fibrosis around the condylar fragment secondary to the delay. There is a paucity of literature concerning the management of these fractures. An oft repeated finding is the requirement of extensive dissection around the fragment for proper reduction. The purpose of this study was to assess the efficacy of surgical management of lateral condylar fractures with delayed presentation. Methods; We assessed the results of lateral condylar fracture fixation in 20 cases with delayed presentation. Results; The lateral condylar fractures in patients with a delayed presentation can be managed surgically with good results. Conclusions; Open reduction and internal fixation should continue to be the method of choice for the management of lateral condylar fractures which report late for management.

Nonunion Of Lateral Humeral Condylar Fracture In A Child With Cubitus Varus

Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.

Osteosynthesis for Nonunion of the Lateral Condyle of the Humerus / 대한정형외과학회잡지

PURPOSE: Although nonunion of the lateral humeral condyle is a rare complication in children, it can result in a number of complications, and treatment is controversial. Our study shows the results of using osteosynthesis in patients whose lateral humeral condyle was not united. MATERIALS AND METHODS: We studies 16 patients (M : F=13 : 3; Age: 11.8+/-5.2 years) who were diagnosed with nonunion of the lateral humeral condyle and who underwent osteosynthesis. The mean period of nonunion was 56.2 months (5-132 months). Outcome measures were range of movement, bone union, functional score, and carrying angle and were assessed both before and after surgery. RESULTS: Bones of all patients were united within 3 months of the operation; there were no complications. After surgery, a decreased range of movement was observed for 3 of 16 patients. However, the functional index for all patients was improved. In other words, the range of movement could be reduced while the functional index was improved so that the deformity would be lessened. CONCLUSION: Osteosynthesis was successful in repairing the nonunion of the humeral lateral condyle. Therefore, osteosynthesis is suggested for patients who have had no treatment for nonunion of lateral humeral condyle for a long time.

Retrospective Review of Kirschner Wire Fixation and Casting for Displaced Lateral Condylar Fracture of the Humerus in Children

This study was conducted to assess the optimum period for Kirschner wire fixation and cast immobilization for displaced lateral condylar fracture of the humerus in children. We retrospectively reviewed 12 patients with displaced lateral condyle humerus fracture, ranging in age from 3-9 y, with injuries that occurred between Jan 2005 and Dec 2006. All patients were treated with two Kirschner wire fixation and elbow immobilization. In all except 2 patients, the Kirschner wires were maintained for 3 to 4 weeks. Mean time for union was 3.78 weeks and mean humeroulnar arch motion at last review was 138.7 degrees. Only one patient had a 5 degree increased carrying angle in valgus as compared to the non-injured side, and 50% had prominent scars > 4mm. We conclude that fracture union can be expected within three to four weeks for most children after open reduction and fixation with 2 Kirschner wires.

Surgical Treatment of Late Presented Displaced Lateral Condylar Fracture of the Humerus in Children / 대한정형외과학회잡지

PURPOSE: To determine whether late open reduction and internal fixation (ORIF) of a lateral condylar fracture (LCF) after 3 weeks is possible, and to determine the latest time for ORIF without a bone graft. MATERIALS AND METHODS: Eight children underwent late ORIF (>3 weeks) of a displaced LCF (>2.5 mm) of the humerus between 3 weeks and 5 weeks after injury. RESULTS: Clinically, results were excellent in 6 cases and good in 2 cases. There was no serious complication, including nonunion and avascular necrosis (AVN), though 2 cases had a slight fishtail deformity and mild carrying angle loss due to overgrowth of the lateral condyle fragment. CONCLUSION: We believe that 3 weeks is too short to deny open reduction and anatomic reduction for fear of AVN of a late presented lateral condyle fracture of the humerus. The latest time for ORIF in late presented LCF in children is around 5 weeks, and surgical treatment may even be possible after greater delays.

Open reduction and rehabilitation of the deformity after humeral lateral condyle fractures in children / 中国矫形外科杂志

[Objective]To investigate etiopathogenisis,modus operandi and rehabilitation in treatment of bone nonunion and residual deformity (cubitus valgus) after humeral lateral condyle fractures in children. [Method]The author retrospective summarized a total of 27 patients diagnosed with humeral lateral condyle fracture follow with bone nonunion and/or cubitus valgus consecutive enrolled in Children’s Hospital of Chongqing Medical University from 2001 to 2006,including 19 cases of male,8 cases of female,16 cases of right humeral lateral condyle fracture and 11 cases of left. The mean age at injured for all the patients (n =27) was 5.6 yr (range 3-10 yr).The mean age at suigical operation for all the patients (n =27) was 9 yr (range 5-14 yr).The average time from injury to operation was 2.8 yr (range 8mon-10 yr).There were three modus operations including direct normal position internal fixation of 7 cases,open reduction following os illium bone graft internal fixation of 11 cases,distant humerus varus wedge shape cut orthopaedic for 9 cases.[Result]Thirteen patients were followed up ranging from 6 month to 2 years,and 14 patients over 2 years. All the patients were achieved union for 8 to 16 weeks after surgery. Elbow deformity had been corrected and function of elbow joint had been recoverd satisfactorily. All of them,excellent rerult were found in 13 cases,good in 11 cases,and poor in 3 cases,the excellent and good rates was 88.9%. None of the cases happened with osteonecrosis,traumatic arthritis and myositis ossificans.[Conclusion]It is common that delay treatment of humeral lateral condyle fractures in children can result in bone nonunion and residual deformity (cubitus valgus) and it is difficult for treatment. Corresponding surgical treatment with different condition and early exercise can improve the appearance and function of elbow joint.

Fine Classification and Treatment Outcome of Lateral Condyle Fracture of the Humerus in Children / 대한정형외과학회잡지

PURPOSE: This paper reports the outcome and complications of a lateral condyle fracture of the humerus in children treated by the fine classification of Jakob stage. MATERIALS AND METHODS: Forty-five cases of a lateral condyle fracture of the humerus in children were treated according to the fine classification of the Jakob stage. There were 4 cases of Jakob stage Ia fractures treated with the application of a simple cast; 16 cases of Jakob stage Ib & IIa fractures treated with a closed reduction and k-wire pinning; and 25 cases of Jakob stages IIb & III fractures treated with an open reduction and K-wire pinning. The average follow-up period was 25 months. RESULTS: Postoperative complications were seen in 18 cases. As minor complications, there were 2 cases of delayed union, 5 cases of hypertrophy of the lateral condyle and 10 cases of osteophyte formation. As major complications, 1 case of avascular necrosis and limitation of motion developed. There were no serious complications such as nonunion, malunion, ectopic ossification, early arrest of the growth plate, and nerve injury. The clinical outcomes were excellent in all but one case of a joint motion limitation. CONCLUSION: The fine classification of the Jakob stage is effective in determining the treatment method for lateral condyle fractures of the humerus in children.

Bony Spur Formation Following Lateral Condyle Fracture of the Humerus in Children / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the incidence, location and contributing factors of the bony spur formation following lateral condyle fracture of the humerus in children. MATERIALS AND METHODS: Sixty four lateral condyle fractures of the humerus followed up until bony union were retrospectively reviewed in the type of fracture, accuracy of the reduction, and the formation, size, location of the bony spur on serial radiographs. Treatment method was recorded. RESULTS: In all children but one case showed bony spur formation in plain radiograph, be it large or small. The size of bony spur was not correlated with the extent of displacement nor treatment methods, but significantly related with the accuracy of reduction. In long term follow-up, the bony spurs decreased in size. CONCLUSION: Accuracy of reduction determinates the size of bony spur following lateral condyle fracture of the humerus in children. In order to prevent or minimize the bony spur formation, accurate reduction is desirable. Even if bony spur formation was present in early healing stage, it can be expected to decrease in size.

Lateral Condyle Prominence Following Lateral Closing Wedge Osteotomy for Cubitus Varus Deformity / 대한정형외과학회잡지

PURPOSE: To define the significant factors for lateral condyle prominence following the lateral closing wedge osteotomy for cubitus varus. MATERIALS AND METHODS: Analyzed the 15 cases performed lateral closing wedge osteotomy for cubitus varus. We measured the carrying angle by the arm and forearm axis lines of soft tissues, lateral condyle prominence index, the distance from center of rotation to osteotomy site and the distance from center of rotation to elbow joint. RESULTS: The lateral condyle prominence group with lateral condyle prominence index (LCPI) over 300% was 5 cases (33%), and no prominence group was 10 cases (67%). The distance between CORA and osteotomy site in lateral condyle prominence group was mean 44 mm (range, 35-52) and no prominence group was mean 21 mm (range, 17-27). The distance between CORA and elbow joint was mean -3 mm (range -15~7) and 16 mm (range, 8-24) respectively. CONCLUSION: Lateral condyle prominence was developed in case of the increased preoperative LCPI, increased distance between CORA and osteotomy site, and decreased distance between CORA and elbow joint.

Clinical application of bone (periosteal) flap of the lateral condyle of femur with the pedicle of the descending branch of lateral circumflex femoral artery / 中华显微外科杂志

Objective To provide a new method to repair nonunion or bone defect of femur Methods The descending branch of lateral circumflex femoral artery anastomosis with the lateral superior genicular artery and the branches distribution of the lateral genicular artery were obsereved on 30 sides of adult cadaveric lower limbs The bone (periosteal) flap of the lateral condyle of femur with the pedicle of the descending branch of lateral circumflex femoral artery was designed and appdied in clinical to repair nonunion or defect in the middle or inferior of femur of 13 patiens Results The follow up period was 14～20 weeks All fracture were unionized and union periods were 13～20 weeks, the results were excellent Conclusion The anatomical location of vessels of this bone (periosteal) flap is enduring, the surgery is simply, the transposition is simble, the influence of donor is very small This bone (periosteal) flap adapt to repair nonunion or bone defect in the middle or inferior of femur

Clinical Study for Lateral Condyle Fracture of Humerus in Children / 대한정형외과학회잡지

From January 1988 to December 1991, 39 fractures of the lateral condyle of humerus in children were treated at the Department of Orthopaedic Surgery, Sung-Ac General Hospital. It was possible to follow up from one year to four years and eleven months. The authors have analyzed the method of treatment on the basis of the degree of displacement in the change of Carrying angle and Baumann's angle. The results were as follows; 1. Of the 39 cases, the age incidence was confined to 2 to 12 years of age and the average age of the patients were 5 years. 2. Most fractures were Milch type II (29 cases) in contrast to Milch type I (10 cases). 3. According to the initial displacement of the fracture, 8 cases were Jokob's stage I, 21 cases of stage II & 10 cases of stage III. 4. There were no significant difference in the range of change of Carrying angle and Baumann's angle according to initial displacement of fracture site. However, significant difference in outcome were noticed from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. 5. In all 39 cases, lateral condylar overgrowth (10 cases), cubitus varus (1 cases) and cubitus valgus (3 cases) were noticed as complications but clinical significance was not noted. 6. The above results suggest that internal fixation is recommended for firm fixation although displacement is not severe. In case of Jakob's stage III, anatomical reduction is required in order to reduce additional damage on articular surface and epiphyseal plate caused by excessive manipulation.

A Clinical Study of Lateral Condyle Fracture of Distal Humerus in Children / 대한정형외과학회잡지

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.