Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution

Abstract

Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob’s classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV.

Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

“…This finding was consistent with previous research, indicating male predominance in lateral condylar fractures in comparison with females (3,4,8). Considering age, fractures mostly occurred in the age group of 5 -8 years, which is in congruence with some previous studies (3,4,8). However, we could not find any similar studies to make further comparisons; therefore, it is essential to determine which type of fracture is more common in boys and this age range.…”

Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures

“…They account for between 12 and 20% of all elbow fractures [2][3][4]. They generally occur in 5-10 year olds [5] and can be easily missed initially [6,7].…”

Outcome of Open Reduction and Internal Fixation in Lateral Condyle Humeral Fractures in Pediatrics

“…It is demonstrated in our study that 83.3% of our patients were males, while 16.7% were females. Leonidou et al [8] reviewed the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). They retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years.…”

“…In our series, it is responsible for all cases; 83.3% of them were type 2 Milch, only 16.7% were type 1 Milch and no one with associated injury. In the study done by Leonidou et al [8], all included cases were the result of low-energy closed injuries. In relation to the Milch's classification, 13 fractures were classified as Milch I and 92 as Milch II.…”

“…In our study, at (3-5) weeks all cases were with soft callus remove K wire; at 8 weeks, all cases were with union fracture; but at 12weeks, one case (8.3%) was with mild stiffness and the rest was with full range of motion. Leonidou et al [8] found that follow-up ranged between 2 and 8 years with an average of 3.2 years. At the final appointment, all patients had achieved full range of movement of the elbow joint.…”