Tardy Ulnar Nerve Palsy Research Articles

Surgical treatment of tardy ulnar nerve palsy due to non-neurogenic heterotopic ossification in the elbow.

Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.

Comparative analysis of surgical outcomes in children with type 3 and type 4 lateral physeal condylar humerus fractures in China: Closed Reduction-PerCutaneous Pinning (CRPP) vs. Open Reduction-Internal Fixation (ORIF)

BackgroundLateral physeal condylar humerus fractures in pediatric patients aged 1–13 rank as the second most common elbow injury, occurring with a frequency ranging from 5% to 16.8%. There exists an ongoing debate regarding the surgical management of these fractures. This study aims to evaluate the efficacy of Open Reduction and Internal Fixation (ORIF) and Closed Reduction and Percutaneous Pinning (CRPP) as suitable surgical treatments for displaced unstable fractures of the lateral condyle physeal humerus in children. The comparison encompasses the results of ORIF and CRPP, alongside clinical and radiographic outcomes and complication rates. MethodA retrospective review was conducted at the Department of Orthopedic Surgery in the research hospital. A cohort of 27 patients treated between 2016 and 2023 were analyzed, 19 patients meeting inclusion criteria. The fracture pattern and degree of displacement were assessed, with specialized radiologists, doctors, and surgeons in agreement. Among the patients, 11 underwent CRPP 7 type 3and 4 type 2, while 16 received ORIF 12 type 4 and 4 type 5. Data collection included fracture type, surgical method, operation time, pre and post-operative displacement, casting period, bone union condition, follow-up records, range of motion, complications, delayed union, lateral spurring, and pin removal records. ResultsFor CRPP, the mean time for pin removal was 5.42 weeks, with excellent bone union and an average operation time of 34.57 min. Criteria of Hardacre showed 28.57% of cases as good and 71.42% as excellent. Similarly, ORIF demonstrated a mean operation time of 42.5 min, with the fracture healing within 5.33 weeks and the pin being removed after 15 days on average. Criteria of Hardacre indicated 25% of cases as good and 75% as excellent. Both groups showed satisfactory outcomes, with no complications such as osteomyelitis, nonunion, malunion, delayed union, myositis ossificans, physeal growth arrest, tardy ulnar nerve palsy, cubitus valgus, or varus, and no cases requiring re-surgery. ConclusionBoth CRPP and ORIF are effective surgical methods for treating lateral physeal condylar humeral fractures (types 3 and 4 according to the Song classification) in children, demonstrating satisfactory outcomes. Notably, regardless of displacement (2 mm and >2 mm), both methods yield similar results, albeit with CRPP offering the advantage of avoiding incisions. Overall, both procedures are safe, with favorable bone healing outcomes.

Treatment outcome of tardy ulnar nerve palsy associated with traumatic cubitus valgus by supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release

BackgroundTardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus. At present, the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus is still controversial, whether these two problems can be corrected safely and effectively in one operation is still unclear. To investigate the supracondylar shortening wedge rotary osteotomy combined with in situ tension release of the ulnar nerve in the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus.MethodsBetween 2012 and 2019, 16 patients who had traumatic cubitus valgus deformities with tardy ulnar nerve palsy were treated with simultaneous supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release. we compared a series of indicators of preoperative and postoperative follow-up for at least 24 months, (1) elbow range of motion; (2) the radiographic correction of the preoperative and postoperative humerus-elbow-wrist angles; (3) the static two-point discrimination and grip strength; and (4) the preoperative and postoperative DASH scores of upper limb function. The minimum follow-up was 24 months postoperative (mean, 33 months; range, 24 ~ 44 months).ResultsThe mean ROM was improved from 107 ° preoperatively to 122 ° postoperatively (P = 0.001). The mean preoperative elbow wrist angle was 24.6 °, and the mean postoperative humerus-elbow wrist angle was 12.1 ° (P < 0.001). The average grip strength and static two-point discrimination improved from 21 kgf and 8 mm to 28 kgf and 4.0 mm (P < 0.001 and P < 0.001, respectively). The ulnar nerve symptoms were improved in all patients except one. The mean HASH score improved from 29 to 16 (P < 0.001).ConclusionSupracondylar shortening wedge rotary osteotomy combined with in situ tension release of ulnar nerve is an effective method for the treatment of traumatic cubitus valgus with tardy ulnar nerve palsy, which restored the normal biomechanical characteristics of the affected limb and improved the elbow joint function.

Management of lateral condyle fractures of the humerus in children.

Lateral condyle fracture of the humerus is the second most common paediatric elbow fracture and is often missed, which can result in severe consequences including malunion, growth arrest and tardy ulnar nerve palsy. The difficulty in managing this fracture stems from a lack of awareness and the often subtle findings on radiographs. Patients can also present with quite vague symptoms; clinicians who do not have a high index of suspicion may not investigate beyond the initial clinical assessment and could miss vital cues. This article provides a guide to managing this common paediatric fracture, from initial presentation to definitive treatment, and discusses the complications that can ensue if managed incorrectly.

OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION

Background:Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization.Purpose:The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions.Methods:In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions.Results:204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone.Conclusion:With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.

Neglected Lateral condyle Humerus Fractures: Current Concepts and Practices

Neglected lateral condyle fractures present varied and difficult challenges to the treating orthopaedic surgeon. They have the potential to cause long term problems like deformities, stiffness, instability and tardy ulnar nerve palsy. The treatment of lateral condyle non-unions depend on the presence or absence of deformity, the duration of non-union, skeletal maturity of the child and the presence or absence of ulnar nerve palsy. Accordingly the treatment ranges from conservative management in neglected fractures with no deformity and no ulnar nerve palsy at one end, Open/mini-open or closed in-situ fixation for established non-unions with instability and corrective osteotomy with fixation of non-union and ulnar nerve transposition at the other end. In this article, the authors have endeavoured to go through the various aspects of clinical presentations and treatment modalities for this difficult fracture. Keywords: Neglected lateral condyle fractures, Cubitus valgus, Tardy ulnar nerve palsy, Instability.

Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position

Background: Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures. Methods: In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with &lt;2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions. Results: Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P&lt;0.001). Tourniquet time was similar between groups (P=0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P&lt;0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation. Conclusions: While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications. Level of Evidence: Therapeutic level III—retrospective cohort study.

Endoscopic Anterior Transposition of Ulnar Nerve (EATUN) for Treatment of Tardy Ulnar Nerve Palsy.

Tardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6-8inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas. In this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results. Seven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed. The minimum follow-up was 12months (Mean 27.4months, Range 12-36months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted. The endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy. Therapeutic Level IV. The online version contains supplementary material available at 10.1007/s43465-021-00366-w.

Severe tardy ulnar nerve palsy due to cubitus valgus deformity: Use of intramuscular anterior transposition

Tardy ulnar nerve palsy is a frequent late complication of post-traumatic cubitus valgus deformity arising due to nonunion lateral condyle humerus fracture. We present a case of a 30 year old homemaker who came with features of tardy ulnar nerve palsy (McGowan grade III) with difficulty in activities of daily living and reduced grip strength. Clinical examination revealed atrophy of hand muscles, claw hand deformity and other features suggestive of ulnar neuropathy. X-rays and CT scan confirmed the diagnosis as fracture lateral condyle humerus nonunion. Surgical intervention in the form of anterior intramuscular transfer of ulnar nerve with neurolysis without addressal of nonunion site was performed. The patient showed complete recovery of sensory and motor symptoms at six months post-op. Anterior transposition of ulnar nerve is a safe and reliable procedure which provides good functional outcomes in cases of tardy ulnar nerve palsy with low morbidity.

A prospective study of malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy Supracondylar humeral fractures are most common elbow fractures in children. The most common complication among all is malunion leading to cubitus varus deformity.Lateral closing wedge osteotomy is the easiest, the safest, and inherently the most stable osteotomy to correct the varus deformity with minimal correction of hyperextension. Aim: To examine the malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy with cubitus varus. Material and Methods: A total of 25 children of malunited supracondylar fracture of humerus were treated by lateral closed wedge osteotomy fixed by two screws and figure of eight tension band wire.The fixation was supplemented with one lateral K-wire. Post-operatively, according to Oppenheim’s criteria patient were evaluated and parents and patient’s satisfaction with final appearance and function of the limb was taken into consideration. Results: According to the Oppenheim et al. criteria, is similar to our study, excellent outcome was noted in 18(72%) cases, good outcome in 5(20%) cases and poor outcome in 2(8%) cases. 18(92%) patients/parentswere satisfied with the final outcome. Conclusion: Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity with less complications.

Cubitus Valgus with Tardy Ulnar Nerve Palsy - Functional Outcome of Milch Osteotomy without Anterior Transposition of Ulnar Nerve.

Introduction:To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.Material and Methods:Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.Results:The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.Conclusion:Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.

Are the standard AP and lateral views enough to detect the rotational malalignment intraoperatively during CRPP of Gartland III pediatric supracondylar humerus fractures

Background: Displaced pediatric supracondylar humerus fractures (SCHF) can lead to residual deformity if not accurately reduced and stabilized. Most publications concerning SCHF reduction have focused on malalignment in the coronal and sagittal plane without considering the rotational malalignment. However, malrotation has been identified in 60% of patients with cubitus varus deformity following a SCHF. In addition, tardy ulnar nerve palsy has been correlated with the degree of internal rotation deformity in these patients. Intraoperatively, inability to restore anatomic rotation can narrow the corridor for intraosseous pinning and make it difficult to obtain a stable …

Cubitus Valgus with Tardy Ulnar Nerve Palsy - Is Anterior Transposition of the Ulnar Nerve Always Necessary? A Case Report

Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.

3D Printing Aided Elbow Deformity Correction

Introduction: Fracture of lateral condyle of humerus is known for nonunion, if not treated properly in children, often leads to a cubitus valgus deformity. For the late presenting cases with deformity and restricted range of motion, surgical management is often challenging, and an appropriate preoperative planning is required. Case Report: We report a case of an un-united fracture of the lateral condyle of the humerus in an adult with a cubitus valgus deformity with early tardy ulnar nerve palsy. He was treated by corrective osteotomy with bone grafting of the nonunion and internal fixation with contoured plates. A virtual preoperative surgical planning was done using 3D printing to define the exact location and direction of the osteotomy, plate contouring and likely place of screw placement to achieve full correction of the elbow deformity. Results: There was good correction of deformity, with union of the nonunion and osteotomy, at three months follows- up. At one year, there was complete recovery of ulnar nerve palsy with excellent function of the elbow and hand. Conclusion: 3D printing is effective in treating complex orthopedic cases and deformity correction. Virtual preoperative surgical planning on the computer and on a 3D model help to study the exact site of osteotomy, plate contouring and screw placement to achieve accurate correction of the deformity. Virtual preoperative planning and 3D printing help in reducing the surgical time and help to achieve desired correction of the deformity.

An unusual case report of tardy ulnar nerve palsy following neglected fracture non-union of me dial epicondyle humerus

Tardy ulnar nerve palsy is a condition presented as late onset ulnar neuropathy. Most commonly occurred as a delayed complication of non-union of lateral epicondyle humerus with valgus deformity. Whereas tardy ulnar nerve palsy occurred as a complication of fracture non-union of medial epicondyle was rare and a very few cases were reported in literature. We report a case in a 15 year old boy with tardy ulnar nerve palsy after neglected fracture non-union of medial epicondyle of humerus on left side, patient presented with tingling and numbness of medial side two fingers with left hand weakness. We treated him operatively by tension band wiring and olecranon bone grafting for fracture non-union medial epicondyle of left humerus and ulnar nerve exploration and anterior transposition was also done. Keywords: Tardy ulnar nerve palsy medial epicondyle fracture non-union ulnar nerve anterior transposition tension band wiring.

Tardy Ulnar Nerve Palsy by Neurofibroma

Tardy Ulnar Nerve Palsy by Neurofibroma

Tardy Ulnar Nerve Palsy.

Tardy ulnar nerve palsy is a chronic clinical condition characterized by a delayed onset ulnar neuropathy after an injury to the elbow. Typically, tardy ulnar nerve palsy occurs as a consequence of nonunion of pediatric lateral condyle fractures at the elbow, which eventually lead to a cubitus valgus deformity. While the child grows, the deformity worsens and the ulnar nerve is gradually stretched until classic symptoms of ulnar nerve neuropathy appear. Other childhood elbow trauma has also been associated with tardy ulnar nerve palsy, including supracondylar fractures resulting in cubitus varus, fractures of the medial condyle and of the olecranon, as well as radial head or Monteggia fractures/dislocation, with or without deformity. The clinical assessment includes obtaining a complete history, physical examination, nerve conduction tests, and elbow imaging studies. Treatment consists of ulnar nerve decompression, with or without corrective osteotomy, with overall successful results usually achieved.

Correction of cubitus varus with lateral closed wedge osteotomy and cross k-wire fixation: results of a prospective series of 19 patients

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy. Various complex corrective osteotomies have been described in literature with no consensus. We conducted this study to evaluate whether a simple lateral closed wedge osteotomy can give predictably good results in these patients. Materials and Methods: Nineteen children with malunited supracondylar fracture humerus leading to cubitus varus deformity underwent lateral closed wedge osteotomy, which was fixed with cross K-wires. Patients were evaluated for carrying angle, elbow range of motion, complications if any, and radiological correction of humeroulnar angle. Results: Osteotomy healed in all patients by 8 weeks (range 4–8 weeks, mean of 5.5 weeks). Excellent correction was achieved in 18 patients, whereas one patient had inadequate correction. Preoperative varus ranging from 10° to 30° (average – 17°) improved to 0°–12° valgus (average-8°). Two patients had minor complications in the form of pin tract infections which resolved with local care and antibiotics. There was no loss of correction or pin loosening. Sixteen patients had excellent result, whereas three patients had fair result as per Bellemore's criteria. Conclusion: Complex three-dimensional osteotomy is not always necessary for cubitus varus correction and a simple lateral closed wedge osteotomy fixed using cross K-wires can give good results with proper planning and execution.

Nonunited medial epicondyle fracture: A threat to ulnar nerve in long run

48yr old male presented with complaints of tingling and numbness over left little and ring finger for one month; with history of injury around elbow 30yrs back which was managed conservatively. He was diagnosed to be suffering from tardy ulnar palsy after Nerve conduction Velocity studies and MRI Study. Injures to elbow are common in childhood, which include fracture of medial epicondyle which may or may not be associated with dislocation. These kind of injures may be managed conservatively or surgically explored. Ulnar nerve is at risk for injury due to its susceptible position behind medial epicondyle which could be due to the direct impact of acute injury, iatrogenic during surgical management or delayed injury due to mal-union with varus or valgus deformity. We report a case of Tardy ulnar nerve palsy without any valgus or varus deformity following non-united medial epicondyle fracture is rare.

Should we repair nonunion of the lateral humeral condyle in children?

Patients with nonunion of the lateral humeral condyle often present with pain, instability, progressive cubitus valgus and tardy ulnar nerve palsy. At present repairing of this nonunion is still controversial due to previous reported complications such as stiffness and avascular necrosis (AVN). This study reported the outcomes of treatment in nonunion of the lateral humeral condyle in children. We evaluated 17 patients with nonunion of the lateral humeral condyle after repair. Corrective osteotomy was done in patients with valgus deformity of more than 30 degrees and anterior ulnar nerve transposition in patients with ulnar nerve symptoms. Evaluations were performed with the use of radiographic examination, clinical assessment and also evaluated using Mayo Elbow Performance score by interview and physical examination interpreted as excellent (≥ 90 points), good (75-89 points), fair (60-74 points), and poor (<60 points). Nine patients were male, and eight were female. The mean age at presentation was 6.5 years. The average interval from the injury to the presentation of the symptoms was 31.5 months. The average duration of follow-up was 48.6 months. The range of flexion was 130-145° (average 130°). The Mayo elbow performance score was excellent in 11 patients and good in six patients. Mean Mayo elbow performance score was 94. Osseous union was achieved after the initial operation in 16 patients. One patient had re-operation using local bone graft and healed nicely. Determination of correlation coefficients found good correlation between neglected time and Mayo performance score <89 (-0.741), age of patient was fairly well correlated with Mayo performance score <89 (-0.635) and ROC curve show that neglected lateral condyle fracture in children more than 28 months will reduce the Mayo score. (1) We support osteosynthesis for children, not only for those who have pain but also for those who are less symptomatic. Good and excellent results by Mayo elbow performance score were found in all patients, and all nonunions were united with good range of motion. (2) Neglecting lateral condyle fracture in children more than 28 months will reduce Mayo performance score to below 89 points. (3) Cases presenting with AVN pre-operatively can still have good results and remodeling potential with congruency of the joint.