Functional and radiological outcome of C-shaped intercondylar fractures in children

Intercondylar fractures of the distal humerus are uncommon in skeletally immature patients. T-intercondylar fractures are classified according to the Toniolo and Wilkins' classification (TWC). However, this classification does not include fractures that involve only the medial or lateral portion of the distal humerus but leave the opposite column intact. The aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcomes of displaced C-shaped intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). We retrospectively reviewed the data of nine children with displaced C-intercondylar fractures that were treated surgically. Age, sex, laterality, mechanism of injury, amount of displacement, type of treatment, fixation method, and outcome were recorded. The outcome of C-shaped fractures was compared with that of T-intercondylar fractures published by the same surgeons in a previous study. A total of nine consecutive patients (median age, 12 years; range, 9–14 years) with displaced C-intercondylar fractures of the humerus (six males and three females) were included; in six cases (67%), the left side was affected. Median follow-up was 2 years (range, 2–6). All patients underwent open reduction and internal fixation by screws (n = 5), Kirschner-wires (n = 3), or both (n = 1). Overall, four out of nine patients developed a total of five complications (55.5%): one case of secondary displacement, one case of fishtail deformity, two cases extension deficit, and one case of limited flexion/extension requiring release. The median Quick DASH score at last follow-up visit was 0 (range, 0–4.5). Functional outcome and complication rate in patients with C-intercondylar fractures were comparable with that of patients with T fractures. C-intercondylar fractures should be added as a class to complete the TWC. Although the fracture line is C-shaped, the prognosis is similar to that of T-intercondylar fractures because, in both cases, fractures are intra-articular and require open reduction and internal fixation. Finally, the complication rate of C-intercondylar fractures is relatively high.