Ashby, Elizabeth

Kobezda, Tamás

Rehm, Andreas

English

Apollo (Cambridge)

Rehm et al. Journal of Orthopaedic Surgery and Research          (2021) 16:698  https://doi.org/10.1186/s13018-021-02855-yLETTER TO THE EDITORDetermining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrographyAndreas Rehm* , Tamás Kobezda and Elizabeth Ashby © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom-mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.We read with interest the recent publication by Wu and colleagues [1]. Weiss et  al. [2] defined a classifica-tion system and treatment for lateral humeral condyle fractures (LHCF) based on fracture displacement and articular congruity: (1) type I displaced < 2  mm: non-operative treatment; (2) type II displaced ≥ 2  mm with intact articular cartilage as seen on arthrogram (all 65 fractures had ≥ 2- < 4  mm displacement): closed reduc-tion and percutaneous pinning (CRPP); (3) type III dis-placed ≥ 2  mm with articular cartilage not intact (all 93 fractures had ≥ 4  mm displacement on radiographs and were thought to have a disrupted articular cartilage with-out this having been confirmed by arthrogram or intra-operative findings: open reduction and K-wire fixation (ORIF). The minor/major complication rate was much higher in the type III (23/9) than the type II group (6/1).Bernthal et  al. [3] reported on 141 LCHFs, 76 treated non-operatively, 14 with CRPP and 51 with ORIF. Those treated with CRPP or ORIF had a significantly reduced absolute arc of motion up to 18 weeks after injury com-pared to non-operative treatment. Nazareth et  al. [4] reported significantly reduced Pediatric Outcomes Data Collection Instrument (PODCI) scores for type II/III fractures at 6 and 12 weeks compared to type I fractures.Li et al. [5, 6] being the same authors as Wu et al. [1] previously reported that the lateral humeral cartilage hinge and fracture stability can be accurately deter-mined with transverse ultrasound (US), based on US examinations performed on children with LHCFs treated between February 2013 and May 2019, without the need for arthrograms.Li et al. [5] stated that the US technique is simple, safe, inexpensive and the most advanced method for deter-mining fracture stability compared to MRI and arthrog-raphy and can effectively avoid inadequate treatment and unnecessary surgery for fractures with 2–4 mm displace-ment with intact articular cartilage. Of 39 fractures with 2–4 mm displacement 14 had an intact articular cartilage as seen on US and were treated non-operatively without further displacement. This indicates that possibly all of Weiss et al.’s 65 type II fractures could have been treated safely without surgery.Li et al. [5] recommended the routine use of their US technique. Considering the former information, we agree with Li et  al.’s [5] recommendation that US should be introduced as a routine investigation which could change how we manage LHCFs in the future, pushing the frontier of safe non-operative treatment from the below < 2 mm to the ≥ 2- < 4  mm group with intact articular cartilage. This could result in a substantial benefit for this patient group since they would be managed without anaesthetic, would not be exposed to surgical risks and would have a quicker functional recovery [3, 4], with cost savings for overstretched health services.Despite the same authors [5] having shown that car-tilage integrity can be identified accurately purely by Open Access*Correspondence:  leoreporting@yahoo.co.ukPaediatric Division, Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, UKPage 2 of 2Rehm et al. Journal of Orthopaedic Surgery and Research          (2021) 16:698 • fast, convenient online submission •  thorough peer review by experienced researchers in your field•  rapid publication on acceptance•  support for research data, including large and complex data types•  gold Open Access which fosters wider collaboration and increased citations  maximum visibility for your research: over 100M website views per year •  At BMC, research is always in progress.Learn more biomedcentral.com/submissionsReady to submit your research ?  Choose BMC and benefit from: using US with the child awake without the need for an arthrogram and it being safe to manage fractures with intact cartilage non-operatively in cast, Wu et al. [1] only described US as a complementary tool with arthrography to assess the integrity of the cartilage hinge. We would like to ask Wu et al. [1] why they started using arthrog-raphy in May 2018 under general anaesthetic after hav-ing successfully used only US for over 5 years previously and why they performed CRPP on 25 children with ≥ 2- < 4  mm displacement with intact articular cartilage in contrary to them having previously reported that there was neither a need to expose these children to an anaes-thetic for an arthrogram nor the need to perform CRPP [5]?AbbreviationsLHCF: Lateral humeral condyle fractures; CRPP: Closed reduction and percu-taneous pinning; ORIF: Open reduction and K-wire fixation; PODCI: Pediatric Outcomes Data Collection Instrument; US: Ultrasound.AcknowledgementsNone.Authors’ contributionsAR contributed to the literature review and manuscript preparation. TK con-tributed to the literature review and manuscript preparation. EA contributed to the literature review and manuscript preparation. All authors read and approved the final manuscript.FundingNone.Availability of data and materialsNot applicable.DeclarationsEthics approval and consent to participateNot applicable.Consent for publicationNot applicable.Competing interestsThe authors declare that they have no competing interests.Received: 19 October 2021   Accepted: 21 October 2021References 1. Wu X, Li X, Yang S, Wang S, Xia J, Chen XL, Shen X. Determining the stabil-ity of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography. J Orthop Surg Res. 2021;16(1):32. https:// doi. org/ 10. 1186/ s13018- 020- 02174-8. 2. Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new clas-sification system predictive of complications in surgically treated pediat-ric humeral lateral condyle fractures. J Pediatr Orthop. 2009;29:602–5. 3. Bernthal NM, Hoshino CM, Dichter D, Wong M, Silva M. Recovery of elbow motion following pediatric lateral condylar fractures of the humerus. J Bone Jt Surg Am. 2011;93:871–7. 4. Nazareth A, Schur M, Schroeder AJ, Whitlock PW, Skaggs DL, Goldstein RY. Obesity as a predictor of outcomes in type III & IV supracondylar humerus fractures. J Orthop Trauma. 2021. https:// doi. org/ 10. 1097/ BOT. 00000 00000 002081. 5. Li X, Shen X, Wu X, Chen X. A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res. 2019;105(3):557–62. 6. Li X, Shen X, Wu X, Zhou Z. The routine cutoff displacement of 2 mm may not reliably reflect the stability of pediatric lateral humeral condyle fractures. Injury. 2020;51:2588–91.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in pub-lished maps and institutional affiliations.

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography.

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

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Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography.

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