Downloaded from http://journals.lww.com/jbjscc by BhDMf5ePHKbH4TTImqenVA9Bu/kT98wMibZgF2LJTZSlyDDOTRdyB0mPrj/SU0m3 on 03/08/2020 Free Vascularized Iliac Crest Bone Graft for the Treatment of a Pediatric Lateral Humeral Condyle Fracture Nonunion A Case Report Paul Chubb, DO, Scott Oishi, MD, and Lisa Lattanza, MD Investigation performed at Shriners Hospitals for Children—Northern California, Sacramento, California F ractures of the lateral humeral condyle are the second most common pediatric elbow fracture 1 , and they ac- count for 15% of all pediatric elbow fractures 2 . In lateral humeral condyle fractures that were treated closed, 28.5% developed nonunion, while all fractures that were treated open healed 2,3 . These fractures are one of the few in children in which nonunion is a relatively common complication 2,3 . The algo- rithm for treating an established nonunion includes open re- duction and internal fixation (ORIF) with bone-grafting 4 . To our knowledge, there is no literature demonstrating the per- centage of treated nonunions that remain ununited, although this has been reported as a complication 5 . It is our experience that if the persistent nonunion is not treated, it can lead to progressive cubitus valgus deformity, elbow instability, and pain in adolescence and adulthood, without surgical options to treat this problem in adulthood 6 . This case report describes a successful option for providing union of the lateral humeral condyle in a patient with continued nonunion after ORIF and bone-grafting. The patient was informed that data concerning her case would be submitted for publication, and both the patient and her mother provided consent. Case Report A ten-year-old right-hand-dominant girl presented to our institution with symptoms of increasing pain and valgus deformity in the left elbow. Eight years prior, she had fallen on an outstretched arm and sustained a lateral humeral condyle fracture, which was treated nonoperatively. The fracture did not heal, and she had developed pain and deformity in the elbow. One year prior to presentation to us, an orthopaedic surgeon had performed a traditional in situ ORIF with iliac crest bone-grafting. On presentation to us, she had tenderness over the lateral humeral condyle. Elbow motion was 0° to 140°, Fig. 1 Anteroposterior radiograph showing nonunion of the left lateral humeral condyle. Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. 1 COPYRIGHT Ó 2012 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED JBJS Case Connect 2012;2:e63 d http://dx.doi.org/10.2106/JBJS.CC.K.00125