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Fishtail deformity — a delayed complication of distal humeral fractures in children

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Abstract

Background

Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children.

Objective

The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology.

Materials and methods

We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures.

Results

Seven children ages 7–14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two.

Conclusion

Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.

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References

  1. Wilson JN (1955) Fractures of the external condyle of the humerus in children. Br J Surg 43:88–94

    Article  CAS  PubMed  Google Scholar 

  2. Bronfen CE, Geffard B, Mallet JF (2007) Dissolution of the trochlea after supracondylar fracture of the humerus in childhood: an analysis of six cases. J Pediatr Orthop 27:547–550

    Article  PubMed  Google Scholar 

  3. Kim HT, Song MB, Conjares JN et al (2002) Trochlear deformity occurring after distal humeral fractures: magnetic resonance imaging and its natural progression. J Pediatr Orthop 22:188–193

    PubMed  Google Scholar 

  4. Marshall KW, Marshall DL, Busch MT et al (2009) Osteochondral lesions of the humeral trochlea in the young athlete. Skelet Radiol 38:479–491

    Article  Google Scholar 

  5. Morrissy RT, Wilkins KE (1984) Deformity following distal humeral fracture in childhood. J Bone Joint Surg Am 66:557–562

    CAS  PubMed  Google Scholar 

  6. Haraldsson S (1957) The intra-osseous vasculature of the distal end of the humerus with special reference to capitulum; preliminary communication. Acta Orthop Scand 27:81–93

    CAS  PubMed  Google Scholar 

  7. Haraldsson S (1959) On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand 38:1–232

    CAS  Google Scholar 

  8. Yang Z, Wang Y, Gilula LA et al (1998) Microcirculation of the distal humeral epiphyseal cartilage: implications for post-traumatic growth deformities. J Hand Surg [Am] 23:165–172

    Article  CAS  Google Scholar 

  9. Wadsworth TG (1964) Premature epiphysial fusion after injury of the capitulum. J Bone Joint Surg (Br) 46:46–49

    CAS  Google Scholar 

  10. McDonnell D, Wilson JC (1948) Fractures of the lower end of the humerus in children. J Bone Joint Surg Am 30:347–358

    Google Scholar 

  11. Hayter CL, Giuffre BM, Hughes JS (2010) Pictorial review: ‘fishtail deformity’ of the elbow. J Med Imaging Radiat Oncol 54:450–456

    Article  PubMed  Google Scholar 

  12. Glotzbecker MP, Bae DS, Links AC et al (2013) Fishtail deformity of the distal humerus: a report of 15 cases. J Pediatr Orthop 33:592–597

    Article  PubMed  Google Scholar 

  13. Baba MA, Mir BA, Halwai MA et al (2013) Bilateral post-traumatic osteonecrosis of the trochlea — a rare case report. IJSRP 3:1–3

    Google Scholar 

  14. Kimball JP, Glowczewskie F, Wright TW (2007) Intraosseous blood supply to the distal humerus. J Hand Surg [Am] 32:642–646

    Article  Google Scholar 

  15. Beaty J, Kasser J (2006) The elbow: physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Rockwood C, Wilkins KE (eds) Rockwood and Wilkins’ fractures in children, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 592–610

    Google Scholar 

  16. Jaimes C, Jimenez M, Marin D et al (2012) The trochlear pre-ossification center: a normal developmental stage and potential pitfall on MR images. Pediatr Radiol 42:1364–1371

    Article  PubMed  Google Scholar 

  17. Hegemann G (1951) Spontaneous aseptic bone necrosis of the elbow. Fortschr Geb Rontgenstr 75:89–92

    Article  CAS  PubMed  Google Scholar 

  18. Patel N, Weiner SD (2002) Osteochondritis dissecans involving the trochlea: report of two patients (three elbows) and review of the literature. J Pediatr Orthop 22:48–51

    PubMed  Google Scholar 

  19. Pruthi S, Parnell SE, Thapa MM (2009) Pseudointercondylar notch sign: manifestation of osteochondritis dissecans of the trochlea. Pediatr Radiol 39:180–183

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Noemi Chavez and Eleni Balasalle for their assistance with manuscript preparation.

Conflicts of interest

None

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Author notes

  1. Srikala Narayanan

    Present address: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Authors and Affiliations

  1. Department of Radiology, Division of Pediatric Imaging, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA

    Srikala Narayanan, Randheer Shailam & Katherine Nimkin

  2. Department of Orthopaedics, Pediatric Orthopaedics, Massachusetts General Hospital, Boston, MA, USA

    Brian E. Grottkau

Authors
  1. Srikala Narayanan
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  2. Randheer Shailam
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  3. Brian E. Grottkau
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  4. Katherine Nimkin
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Corresponding author

Correspondence to Katherine Nimkin.

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Narayanan, S., Shailam, R., Grottkau, B.E. et al. Fishtail deformity — a delayed complication of distal humeral fractures in children. Pediatr Radiol 45, 814–819 (2015). https://doi.org/10.1007/s00247-014-3249-9

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  • DOI: https://doi.org/10.1007/s00247-014-3249-9

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