<p>Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review</p>

Abstract

Objective: Lateral humeral condyle fractures are the second most common elbow fractures in children. Both K-wire fixation and screw fixation have been advocated as suitable treatment options for displaced fractures. This study aimed to identify which fixation method was associated with the best functional outcomes. Methods: A systematic review was conducted. Studies reporting functional outcomes following surgical fixation of lateral condyle fractures were included for review. The primary outcome measure was functional outcome. The secondary outcome measure was major complications. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies. Results: Ten retrospective non-randomised, comparative studies were eligible and included. No randomised-controlled trials were identified. The highest rate of excellent functional outcomes was seen with screw fixation (120/126 [95%]), compared with K-wire fixation (135/162 [86%]). The incidence of major complications was comparable, with complications in 6/95 (6%) of screw fixations and 6/141 (4%) K-wire fixations. A small sample of data on closed reduction demonstrated excellent functional results in 73 of 76 (96%) of patients. Closed reduction of displaced fractures is associated with a significant learning curve however. Conclusion: The evidence was of poor quality and comprised of retrospective case series. This prevented meta-analysis and any firm conclusions being drawn from the available data. Screw fixation may be associated with improved functional outcomes. Complication rates between the two methods are comparable. Further prospective studies are recommended.

Cannulated Screw Versus Kirschner Wire Fixation Following Open Reduction of Lateral Condyle Fracture of Humerus

“…However, the authors found that K-wires had less capacity to compress and retain the fragments in place. In a systematic review, Birkett et al [5] found that the highest rates of excellent functional outcome were seen with lag screw fixation (95%) compared to K-wire fixation (83.3%), but the results were comparable between two groups.…”

“…The optimal method of fixation for maintaining reduction is still debated [4]. In a systematic review of ten retrospective comparative studies [5], no firm conclusions Inclusion criteria were lateral condyle fractures of humerus with more than 2 mm displacement, between 5 to 12 years of age and less than 2 weeks duration since injury. Exclusion criteria were fractures associated with ipsilateral humerus or forearm fractures and children with bicondylar fractures or comminuted fractures of the distal humerus and lateral condyle fractures with a small metaphyseal fragment.…”

Complications of Lateral Humeral Condyle Fractures in Children

“…Good results have been reported with both K-wires and screw fixation for LCHF in the literature [7,13,24,33,34,35,36]. Recent studies have favoured screw fixation over K-wires due to reduced cast time, earlier mobilisation, reduced infection rates, fewer non-union rates, faster time to union due to compression at fracture site and overall better motion at follow up [7,13,24,27,33,34].…”