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Free Vascularized Iliac Crest Bone Graft for the Treatment of a Pediatric Lateral Humeral Condyle Fracture NonunionA Case Report
Paul Chubb, DO1; Scott Oishi, MD2; Lisa Lattanza, MD3
1 Wellspan Orthopedics, 2319 South George Street, York, PA 17403
2 Texas Scottish Rite Hospital for Children, 2222 Wellborn Street, Dallas, TX 75219
3 Hand, Upper Extremity, and Microvascular Surgery Center, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158. E-mail address: latanza@orthosurg.ucsf.edu
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Investigation performed at Shriners Hospitals for Children—Northern California, Sacramento, California

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.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2012 Oct 24;2(4):e63 1-5. doi: 10.2106/JBJS.CC.K.00125
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Fractures of the lateral humeral condyle are the second most common pediatric elbow fracture1, and they account for 15% of all pediatric elbow fractures2. In lateral humeral condyle fractures that were treated closed, 28.5% developed nonunion, while all fractures that were treated open healed2,3. These fractures are one of the few in children in which nonunion is a relatively common complication2,3. The algorithm for treating an established nonunion includes open reduction and internal fixation (ORIF) with bone-grafting4. To our knowledge, there is no literature demonstrating the percentage of treated nonunions that remain ununited, although this has been reported as a complication5. 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 adulthood6. 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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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