Fixing Fractures of the Lateral Humeral Condyle

This retrospective study assessed the impact of stabilization method on complication rate after lateral humeral condylar fracture (LHCF) repair (n = 135) in 132 dogs. LHCFs are intra-articular fractures most commonly seen in skeletally immature animals; they are often traumatic in origin. Transcondylar screws inserted in lag fashion is probably the most common method of fixation, with a second fixation point (most commonly using K-wire) to prevent rotation of the lateral fragment around the axis of the screw. Few studies have compared differing surgical treatments of LHCF. Surgical LHCF repair methods in this study of dogs included transcondylar screw and supracondylar K-wires (n = 61), transcondylar screw plus supracondylar screw (n = 13), and transcondylar screw plus lateral epicondylar plate (n = 61). Major complications were seen significantly more frequently with transcondylar screw and supracondylar K-wire fixation than with stabilization using supracondylar screws or lateral epicondylar plates. Dogs with major complications were significantly more likely to have poor outcomes. Although an increase in anesthesia time led to an increased rate of postoperative infection, no association was seen between duration of anesthesia and fixation method. Interestingly, no correlation was found between accuracy of reduction and long-term outcome. More studies are needed to clarify the effects of age, weight, and postoperative antibiotic usage on outcome of LHCF repair.

Commentary

Humeral condylar fractures are articular fractures that are challenging to repair and have a high complication rate. The most common method of fixation of lateral humeral condylar fractures is use of a transcondylar screw in lag fashion and placement of an anti-rotational pin. This study showed a lower complication rate when a supracondylar screw or lateral epicondylar plate was used instead of a pin. Use of a screw or plate instead of a pin should be considered, particularly in dogs that have confounding factors such as supracondylar comminution or evidence of incomplete ossification of the humeral condyle.—Brenda Salinardi, DVM, MS, DACVS