Lateral Humeral Condyle Fractures Research Articles

Nonunion of lateral humeral condyle fracture with progressive cubitus valgus in children: How to address the challenge?

Nonunion of lateral humeral condyle fracture with progressive cubitus valgus in children: How to address the challenge?

Corrective osteotomy and in situ fusion for late-presenting nonunion of lateral condyle fractures of the humerus in adults

Late presentation of lateral condylar fractures of the humerus is not an uncommon problem in children, and to lesser extent, in adults. The various surgical interventions for repairing the fracture, correcting the deformity, or even performing anterior transposition of the ulnar nerve as a single procedure or in combination, especially in adults, is still a controversial topic, with a paucity of literature regarding this. There is a risk of loss of the available preoperative range of motion, nonunion, and avascular necrosis. In 19 patients with late presentation of lateral humeral condyle fracture, we assessed the results of only corrective osteotomy and internal fixation with lateral incision without anterior transposition of the ulnar nerve with regard to deformity correction, union, and functional results using the Mayo Elbow Performance Score with at least 24 months of follow-up. All patients (14 men, 5 women; average age, 29.1 years) had Milch type 2, 18 patients presented with cubitus valgus deformity, 1 presented with cubitus varus deformity, and 8 patients had tardy ulnar nerve symptoms. Late-presenting lateral condylar fractures could be managed surgically with our procedure alone even if they have a tardy ulnar neuritis, with excellent results in 17 patients and good results in 2 patients. In situ fusion, deformity correction, and internal fixation is a valuable method for the management of late-presenting lateral condylar fractures in adults.

Paediatric lateral condyle fractures of the distal humerus

Lateral humeral condyle fractures are the most common intra-articular fracture of the skeletally immature elbow and the second most common elbow fracture in children (approximately 16%). Inadequately treated fractures can lead to non-union and growth disturbance which results in deformity and loss of function. Controversy remains regarding the management of these fractures, as there are no randomized controlled trials of treatments and the literature consists mainly of retrospective case series. In this article, we will present the key points from the literature currently available. This includes recent articles that define the consistent fracture plane and studies that suggest the optimal imaging techniques to determine amount of displacement, which is an important factor for prognosis, unlike medial epicondyle fractures. We offer pragmatic management strategies for lateral humeral condyle fractures.

In vivo 3-dimensional Kinematics of Cubitus Valgus after Non-united Lateral Humeral Condyle Fracture.

BackgroundNonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan.MethodsEight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, 90° flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion.ResultsUlno-humeral joint moved to the varus on the coronal plane during flexion, 25.45° in the non-united cubitus valgus group and -2.03° in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane -26.75° in the non-united cubitus valgus group and -3.09° in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern.ConclusionsThe non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.

Measurement Reliability in Pediatric Lateral Condyle Fractures of the Humerus.

Lateral condyle fractures of the distal humerus are the second most common pediatric elbow fracture. A difference of 1 or 2 mm in fracture displacement measurement may change the operative or nonoperative management of a minimally displaced fracture. The goal of this study was to determine the interobserver and intraobserver agreement in the measurements of displacement of lateral condyle fractures of the humerus. A retrospective radiographic review of 60 patients was performed by 3 reviewers. Fracture displacement was measured in millimeters on all radiographic projections and repeated by a single author 1 month later. Intraclass correlation coefficients (ICC) were calculated for intraobserver and interobserver agreement. We then calculated the percentage of measurements that differed by >1 or 2 mm. Analysis was performed on the entire cohort of displaced fractures and again separately for a cohort of minimally displaced fractures (defined as <5 mm). The combined ICC for intraobserver reliability across all radiographic projections was 0.96 (range, 0.952 to 0.977), but there was disagreement between a single reviewer's own measurements 17.3% of the time. Within the cohort of fractures displaced <5 mL, this intrarater disagreement (>2 mm) dropped to 4%. Interobserver reliability was also high with an ICC of 0.90 (range, 0.861 to 0.924). Within the minimally displaced cohort (<5 mm), the interrater disagreement was 6.6% when using a 2 mm cutoff and 22.2% when using a 1 mm cutoff. Intraobserver and interobserver reliability are high when measuring lateral condyle fractures and the percent of clinical disagreement is low when measuring minimally displaced fractures for which treatment depends on measuring to the millimeter. The internal oblique projection is the most reliable view for measuring lateral condyle fracture displacement, whereas the external oblique view offers little in terms of reliability. This study may be used as a platform for further research, verifying that reliable measurements of lateral humeral condyle fracture displacement can be obtained within 1 to 2 mm from adequate plain films. Level III.

Anterolateral approach for lateral humeral condylar fractures in children: Clinical results.

To evaluate the clinical outcomes of an anterolateral approach for lateral humeral condylar fractures in children. The patients aged < 15 years undergoing surgery with an anterolateral approach for humeral lateral condylar fractures between April 2005 and March 2014 were investigated. Medical records and radiographs from 15 patients were reviewed. Average patient age at surgery was 6.0 years (range, 3–10 years). Based on Jakob's classification, 12 patients had type II fractures, and 3 patients had type III fractures. Based on Milch classification, 1 elbow was type I, and 14 elbows were type II. The average postoperative follow-up duration was 16.4 months (range, 6–58 months). Postoperative complications, and radiographic and clinical findings, including range of motion and Flynn criteria were evaluated. To evaluate humeral deformity, Baumann angle (BA) and the carrying angle (CA) were calculated on anteroposterior radiographs. There were no postoperative complications, including secondary displacement, deep infection, nonunion, avascular necrosis, or cubitus varus or valgus deformity. In the injured elbow, follow-up radiographs revealed an average BA of 69.1° (range, 57–84°), versus 70.9° (range, 61–83°) on the contralateral side. The average CA on the injured side was 10.3° (range, 4–20°) versus 12.3° (range, 6–24°) on the contralateral side. BA gain and CA loss (affected- compared with contralateral sides) averaged −1.4° (range, −17° to 9°) and 2.3° (range, −2° to 6°), respectively. The mean range of motion in the affected elbow averaged 4.7° (range, 0–15°) in extension and 139.7° (range, 135–140°) in flexion. Over 5° loss of range of motion in the affected elbow compared with the contralateral side was not observed. However, 2 patients experienced over 5° loss of CA in the affected elbow versus the contralateral side. Based on Flynn criteria, clinical results for both cosmetics and function were excellent in 13 patients, and good in 2. The advantages of the anterolateral approach are combining an optimal view of the anterior articular surface of the trochlea and capitellum and a limited risk of devascularization injury. We strongly recommend an anterolateral approach for these fractures in children to prevent postoperative deformity and to achieve anatomical reduction and reliable fixation.

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

Pining Fixation Versus Canulated Screw with Open Reduction of Pediatric Lateral Condyle Humerus Fractures

Good results have been described for lateral condyle Fractures pediatrics treated by open reduction and fixation usingKirschner wires or screws.We, in our level III retrospective comparison clinical research study, retrospectively reviewed 20patients (10 K-wire, 10 screw fixation; average age 5.6 years, average follow-up 6.8 months). The clinical outcomes wereevaluated according to the criteria of Hardacre et al. There was no statistically significant difference in clinical outcomebetween these two groups. Two patients developed skin infection around K-wires, while no infection occurred in fracture withscrews. An obvious lateral prominence occurred in one patient with K-wires and none with screws. One patient with K-wiresand one patient with screws had a lack of 15° of extension of the elbow compared with the other side. With K-wires therewere two nonunions (average time to union 9.6 weeks). With screws, one nonunions (average of 6.8 weeks). Both K-wires andcannulated screw fixation are effective in treatment for lateral humeral condyle fracture. K-wires can pass through the ossificnucleus of capitulum without damaging it, but a longer period of external fixation and local skin care will be required. Screwfixation patients spent fewer days in a cast and had agreater range of motion at the last follow-up. Screw fixation is associatedwith fewer nonunions and faster time to union, but a secondary procedure for removal is required .

Arthroscopically Assisted Surgery for Lateral Humeral Condyle Fractures in Children; Case Series

Arthroscopically Assisted Surgery for Lateral Humeral Condyle Fractures in Children; Case Series

Surgical Results of Posteolateral Approach for Pediatric Lateral Humeral Condyle Fractures

Surgical Results of Posteolateral Approach for Pediatric Lateral Humeral Condyle Fractures

Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated tenpatients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24months. Only childern with post-operative follow up more than 24months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3months with average post-operative follow up of 44.3months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p < 0.05). All six patients that had pre-operative various degrees of ulnar nerve affection had completely improved at last follow up. The osteotomy site united in an average time of 43days, whereas the LHC nonunion site united in an average time of 77.2days. The osteotomy site united in significantly less time than the LHC non-union site (p < 0.05). The correlation between time since injury and time of union of LHC non-union site was significant (p < 0.05). Post-operative elbow range of motion was not changed in five patients, slightly decreased in four patients, and increased in one patient. Three patients had an average 6.7 degrees (range; 5-10) loss of the last degrees of flexion. One patient developed extension lag of 10 degrees. The mean elbow range of motion (ROM) pre-operatively was 139 ± 4.6 degrees while the mean post-operative ROM was 138 ± 5.3 degrees. The difference was found to be statistically insignificant (p > 0.05). The mean pre-operative Mayo elbow performance score was poor 55 ± 9.7, four patients had fair score, and six had poor score. The mean post-operative Mayo elbow performance score was excellent 92.5 ± 10, six patients had excellent score, and four had good score. The improvement of the Mayo score at the last follow up was found to be statistically significant (p < 0.05). No intra-operative complications were recorded during any of the procedures and no patient developed a wound or pin track infection post-operatively. At the last follow up, none of the patients had developed avascular necrosis of the LHC. Preservation of the blood supply of the nonunited fragment is the key to successful management. This combined technique successfully addresses different aspects of the problem simultaneously and provides a durable solution without deterioration of the results over time. The para-triceptal approach provided excellent exposure of both sides of the elbow with minimal disruption of the triceps muscle.

Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population.

This study was conducted to explore epidemiologic features of traumatic elbow dislocation with associated fractures in pediatric population following appropriate treatment options.Incidence of elbow dislocation with associated fractures was analyzed in 67 children using elbow radiographs. Treatment for the displaced elbow joint was performed by closed reduction and proper immobilization. Surgical intervention was applied to restore the correct alignment of the fracture. Mayo Elbow Performance Score (MEPS) was used to measure elbow joint function.Incidence of pure dislocation was observed in 7 of 67 children (10.45%). Elbow dislocation was typically accompanied by a single or multiple fractures in 39 (58.21%) and 21 (31.34%) of 67 children, respectively. In contrast, lateral humeral condyle fracture and medial humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow fractures. All children with elbow fracture-dislocations received surgical intervention by open reduction and internal fixation. During follow-up, 56% to 92% of children displayed significant recovery of elbow function with improving MEPS after the displaced elbow and fractured fragments were reduced and held in place for weeks. There were statistical differences in MEPS between the types of fractures (P < .05 or P < .01).Incidence of isolated elbow dislocation without fracture is low; rather, it is frequently associated with fractures. Early surgical intervention achieves stable fixation and bony union with utility in improving elbow function in the pediatric population.

A 3-Dimensional Analysis of the Fracture Planes in Pediatric Lateral Humeral Condyle Fractures for Image-Based Pin Positioning During Fixation.

To determine the 3-dimensional morphology of pediatric lateral condylar physeal fractures using 3-dimensional computed tomography (3D-CT) and to identify optimal pin positions for percutaneous pinning. Prospective case series of consecutively treated patients. Tertiary university hospital setting. Preoperative 3D-CTs in pediatric surgical candidates diagnosed with lateral condylar physeal fractures. Closed reduction and percutaneous pinning was performed. Reconstructed images of the distal humerus were aligned accordingly to determine the coronal (α), sagittal (β), and axial tilt (γ) angles of the fracture plane. Both α and β were also measured on plain radiography. Image-based position of the 2 pins was calculated preoperatively using 3D-CT, based on anteroposterior and lateral views. Final angle of pins was measured on postoperative radiographs. A total of 29 fractures were assessed. 3D-CT reconstruction images of fractures showed a posterolateral fracture fragment with reference to the long axis of the humerus. The mean α, β, and γ were 62 degrees [95% confidence interval (CI), 59-64], 69 degrees (95% CI, 65-72), and 36 degrees (95% CI, 34-38). Both α and β measured on plain radiography were not significantly different from 3D-CT measurements (P = 0.6712, 0.6218). Average postoperative pin angles were 144 degrees (95% CI, 140-147) and 161 degrees (95% CI, 158-165) for the proximal pin, and 118 degrees (95% CI, 114-122) and 115 degrees (95% CI, 110-120) for the distal pin, on anteroposterior and lateral views, respectively, resulting in similar trajectories to the preoperatively calculated pin positions. Our study adds to the current knowledge by providing an image-based angular reference of the fracture configuration in pediatric lateral humeral condyle fractures, which may be used during percutaneous pinning. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Infected gap nonunion of fractures proximal humerus in adolescent: an outcome of 12 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is little data about the risk factors, demographics, and prognosis for nonunions in children. Previous literature has reviewed time periods when contemporary techniques of internal fixation and management of open injuries had not been available. Infected gap nonunion of proximal 1/3 humerus in adolescent is not much reported the in literature. The purpose of our study was to evaluate the outcome of infected gap nonunion in 12 cases of adolescent treated by debridement and fibular graft and plating.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted between 2009 to 2015, 12 cases of Infected gap nonunion of fractures proximal humerus was included in our study. Each child was followed up minimum for 12 months. Although non unions in the pediatric population are rare, these data underscore the importance of careful evaluation and treatment of these fractures at risk for nonunion.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our series of 12 cases of infected nonunion of fracture humerus which were treated by bone grafting using fibula strut graft and plating resulted 99% union rate. The rate of union is depending on thorough debridement and fixation along with bone grafting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nonunion of pediatric fractures is a rare complication. Most studies on developing pediatric nonunions describe specific fractures that are particularly susceptible to nonunion and malunion, nonunion of humeral lateral condyle and open tibia fractures have received the most attention. Reports of nonunion among pediatric long bone fractures are rare, being either case reports or isolated entities in a larger series of predominantly adult fractures. Fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity.&lt;/p&gt;

Relevance of MRI for management of non-displaced lateral humeral condyle fractures in children

IntroductionThe treatment for non-displaced (<2 mm displacement) fractures of the lateral humeral condyle in children is controversial. Most studies recommend non-surgical treatment. However, plain radiographs are not sufficient to evaluate extension of the fracture line through the articular cartilage. This explains the high frequency of secondary displacements and non-unions, despite well-conducted conservative treatment. We hypothesized that MRI could be used to analyse whether the fracture is complete or incomplete. This could help to determine whether surgical or conservative treatment is indicated. Material and methodsThis prospective study enrolled children being treated for a non-displaced (< 2 mm gap) fracture of the lateral humeral condyle. All patients were treated with a long-arm cast in the emergency room. An MRI was done later on without sedation. A specific protocol was used to reduce the duration of the examination. T2-weighted and proton density fat-saturated sequences were used. ResultsTwenty-seven patients were enrolled: 16 boys and 11 girls with a mean age of 5 years (2–10). The MRI was performed an average of 7 days (1–23) after the fracture. The MRI could not be interpreted in two cases because the child had moved during the examination. In the other 25 patients, the fracture was incomplete in 17 patients and complete in 8 patients. Two children had secondary displacement diagnosed 7 and 11 days after the fracture event. These two patients underwent open reduction and internal fixation. There was no correlation between patient age and the fracture being complete or incomplete. There were no cases of non-union. ConclusionMRI appears to be a reliable method for determining whether the fracture line is complete or incomplete. It can be performed without sedation, even in children as young as 2 years of age. Use of an injury-specific MRI protocol reduces the length of the examination, thereby improving its performance. We recommend that it be used to analyse non-displaced fractures of the lateral humeral condyle in children. Level of evidence3 Prospective study.

Open reduction and percutaneous pinning fixation for the treatment of fractures of the lateral humeral condyle with an early delayed presentation in children

目的 评价切开复位经皮钢针固定手术治疗儿童早期陈旧性肱骨外髁骨折的中短期疗效。 方法 自2004年1月至2012年3月，共收集我院16例儿童早期陈旧肱骨外髁骨折患者，男12例，女4例，左侧10例，右侧6例，12例畸形愈合，4例不愈合，均行切开复位钢针固定手术治疗，伤后至手术时间平均为7.4周(3.0～15.6)周，评价手术治疗后的影像学变化及肘关节功能。 结果 患儿平均随访时间为4年(1.1～8.9)年，平均随访年龄为8.7岁(3.2～17.8)岁。根据Dhillon评分系统标准，肘关节功能评分从术前(3.3±1.8)分提高到随访时(5.6±2.4)分，总评分从术前(5.6±1.1)分提高到随访时(8.5±0.5)分。其中7例患儿出现鱼尾畸形，8例患儿出现了肱骨外髁骨骺的部分早期闭合。所有患儿均未发生肱骨小头缺血性坏死。双侧肱骨髁宽度(4.258±4.622)mm、双侧肱骨角(7.063±6.496)°、双侧肱骨小头前倾角(8.000±10.520)°，双侧肱骨长度(5.633mm±4.177)mm，提携角(2.875±7.509)°，尺骨角(3.313±8.585)°。 结论 伤后16周内的儿童陈旧性肱骨外髁骨折，行切开复位钢针固定的中短期疗效良好。

Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls.

Lateral humeral condylar fractures are the second most common elbow fractures in children. We present the long-term clinical and radiographic results. All children (<16years) in the geographic catchment area with lateral condylar fracture were asked to participate and 32 (76.2%) patients enrolled. Clinical and functional results are compared with randomly selected but age and sex matched normal controls at 12.4years (range 10.6 to 16.0). Unsatisfactory clinical outcomes were found in 40.6% of the fracture cases vs. 6.3% controls (P = 0.003), according to Flynn's criteria. Flexion-extension range of motion was decreased >5° in 13 cases (40.6%) and in four controls (12.5%, P = 0.013). One in four (N = 8, 25%) of the cases showed cubitus varus >5° and 15.7% (N = 5) had cubitus valgus >5°, compared to one cubitus valgus (3.1%) in controls (P = 0.002). The majority of the adolescent and young adult patients (59.4%) with a previous paediatric lateral humeral condylar fracture had recovered well and showed good or excellent overall outcomes according to Flynn's criteria for elbow assessment after a mean of 12.4years post-injury. Long-term sequelae was unchanged regardless of treatment.

Conservative Management of Minimally Displaced (≤2 mm) Fractures of the Lateral Humeral Condyle in Pediatric Patients: A Systematic Review.

Fractures to the lateral humeral condyle are common in the pediatric population and can lead to complications related to displacement of the fracture fragment. The ideal treatment for minimally displaced fractures (measuring ≤2 mm) is controversial. A systematic review was performed identifying and evaluating studies related to displacement of lateral humeral condyle fractures in pediatric patients. Databases included in this review were PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE. We investigated the rate of subsequent displacement for minimally displaced fractures following immobilization, the time span in which fracture displacement occurs, and the complications related to displacement despite immobilization. Our review of the literature found 6 studies that matched the search criteria. The risk of subsequent displacement in minimally displaced fractures initially treated with immobilization was 14.9% with fracture displacement typically occurring within the first week following injury. Malunion, nonunion, and loss of motion were the most commonly identified complications following subsequent displacement. For minimally displaced fractures of the lateral humeral condyle, appropriate diagnosis of fracture stability and fracture displacement with close radiographic follow-up 1 week following injury dictate the success of conservative management. Level II-systematic review of level-II or level-I studies with inconsistent results.

Surgical treatment for 14 patients with old fractures of humeral lateral condyle in children

To study clinical effects of operation for the treatment of old fractures of the humerus lateral condyle in children. From January 2012 to January 2014 in our department, 14 children of old humeral lateral condyle fractures were treated with operation. Ten cases were male, 4 cases were female; age from 2 to 12 years old, average 5.8 years old. The initial diagnosis was type IIfracture according to the Milch ciassification, the loss of treatment in 11 cases, conservative treatment in 3 cases of nonunion after fracture displacement. Two cases had mild cubitus valgus deformity; 10 cases had elbow disorders, and the motion range was limited from 15° to 60°; 6 cases had pain in activity. The time from injury to operation was 32 to 176 days(62 days on average) in 14 cases, the 14 cases were treated with open reduction and internal fixation. According to the Modified An-Morrey elbow function assessment criteria after surgery for curative effect. Fourteen cases were followed up for 1 to 3 years, average 1.8 years. No nonunion, malunion, aseptic necrosis of the epiphysis, cubitus varus or valgus occurred. Five cases had mild protrusion deformity of external condyle, 3 cases still had mild dysfunction. The time of clinical bone union was 4 to 8 weeks in X-ray films. Five cases had bony spur formation, 3 cases had signs of early closure of epiphysis; 2 cases had a increasing volume of humeral lateral condyle; and 2 cases appeared tail deformity. Modified An-Morrey score averaged(95.2±3.6) points, 13 excellent, 1 good. For the old fracture of humeral lateral condyle, operation can effectively restore the appearance and function of elbow joint, and the short-term curative effect is satisfactory, but the long-term effect needs further observation.

Cannulated Lag Screw Fixation of Displaced Lateral Humeral Condyle Fractures Is Associated With Lower Rates of Open Reduction and Infection Than Pin Fixation.

Open reduction/internal fixation remains the most common way to surgically stabilize displaced pediatric lateral humeral condyle fractures, but closed reduction and internal fixation is being increasingly used. Our goal was to compare the clinical and functional results of treating displaced pediatric lateral humeral condylar fractures with traditional smooth or threaded pin fixation versus single cannulated screw fixation. From 1998 through 2012, the lateral humeral condyle fractures of 48 patients were treated with pin fixation (22 patients, until 2006) or cannulated, partially threaded screw fixation (26 patients, from 2006 onward). In each, closed reduction with percutaneous fixation was attempted first, followed by open reduction if anatomic reduction was not achieved. For the pin and screw groups, preoperative maximum radiographic displacement averaged 8.4 mm (range, 3.8 to 18.4 mm) and 6.3 mm (range, 2.2 to 15.5 mm), respectively; follow-up averaged 4.3 months (range, 1.5 to 20 mo) and 10.3 months (range, 2 to 30 mo), respectively. We reviewed preoperative and postoperative images and all follow-up clinical examination findings; serially assessed initial displacement, Baumann and carrying angles, range of motion limitations, and clinical alignment; evaluated functional results via the system of Hardacre and colleagues; and investigated all complications. Open reduction was required in 73% (16/22) and 15% (4/26) of the pin and screw groups, respectively (P<0.001). All fractures were reduced to <1 mm postoperative displacement. Postoperative immobilization averaged 5.9 weeks (range, 4 to 11 wk) and 4.5 weeks (range, 3 to 8 wk) for the pin and screw groups, respectively. The only significant difference in complications was the infection rate: 5 (1 deep) in the pin group and none in the screw group (P<0.05). Closed reduction and percutaneous 4.5-mm lag screw fixation of displaced pediatric lateral humeral condyle fractures is safe and reliable, enabling a higher rate of closed reduction, significantly lower infection rate, and earlier mobilization than traditional pin fixation. Level III-Therapeutic.