The safety and efficacy of closed reduction and percutaneous pinning with an intraoperative arthrogram for Grade 2 and Grade 3 pediatric lateral condyle fractures

Abstract

Objectives: It is controversial whether pediatric lateral humeral condyle fractures (LHCFs) with >2 mm displacement can be managed using closed reduction and percutaneous pinning (CRPP) as opposed to open reduction. This study assesses the clinical, radiographic outcomes, and complication rates of patients undergoing arthrogram-assisted CRPP for fractures with >2 mm of displacement rather than open reduction and internal fixation. Methods: This study was conducted retrospectively, looking at all children presenting acutely with LHCFs that were displaced >2 mm between January 2017 and December 2019 whom one surgeon treated within 48 hours of the initial injury. Sixteen patients met the inclusion criteria. Pre-operative and post-operative anteroposterior as well as lateral radiographs were used to measure displacement and classify fractures. A subgroup analysis was done to compare the results in Grade 2 and 3 fractures as per Weiss classification. Results: Signs of union were observed in all patients at 2 weeks and all fractures were healing well at 6-week follow-up, regardless of fracture grade or displacement. Post-operative complications including pin site infections, valgus deformity, non-union, or malunion were not seen. A higher proportion of Grade 3 patients developed heterotrophic ossification and limitation of range of movement. Conclusion: Arthrogram imaging is a valuable tool to help visualize the articular cartilage surface and determine the suitability of CRPP for LHCF with >2 mm displacement. It is a safe option with good outcomes and provided that there is no significant articular cartilage incongruity seen under fluoroscopy.