T-condylar fractures of the humerus are rare and surgical treatment can be very challenging. The current standard of care for this injury is open reduction and internal fixation, which requires an extensile approach, extensive soft tissue stripping and sometimes an olecranon osteotomy. We have successfully used small-wire external fixation to manage this fracture. The purpose of this study is to assess the clinical and functional outcomes of our pediatric patients with T-condylar fractures of the elbow that were treated with the Ilizarov external fixator.
We performed a retrospective review of all children and adolescents with T-condylar fractures of the humerus treated by two surgeons with the Ilizarov external fixator. The medial records and radiographs were reviewed for mechanism of injury, operative times, duration of time in the frame, and complications.
Fifteen patients (11 males and 4 females) met the inclusion criteria. The mean age at injury was 11.5 years (range 8-15 years). By the OTA Fracture Classification 85% were C1.1 fractures, 7% were C2.1 fractures, and 7% were C2.2 fractures. Three patients had ipsilateral fractures of the upper extremity, and there was one Grade I open fracture. The mean operative time was 113 minutes (range 60-150 minutes). Only one patient required an intraoperative arthrogram to assess the reduction. The mean time in frame was 57 days (range 35-115 days). Complications included persistent serous drainage from pin sites while in the frame (3), transient ulnar neuropraxia (1), loss of flexion (2), loss of extension (1), and malunion causing cubitus varus (1). There were no pin tract infections. The average lateral distal humeral angle was 89 degrees at follow-up. The anterior humeral line intersected the capitellum in all cases except the one malunion.
The Ilizarov external fixator can safely and effectively manage T-condylar humerus fractures in children and adolescents. The technique allows restoration of the articular surface while providing sufficiently rigid fixation to permit immediate post-operative range of motion. This approach obviates the need for extensive soft tissue dissection, periosteal stripping, disruption of the fracture hematoma, and an olecranon osteotomy.