Open reduction of pediatric lateral condyle fractures: a systematic review

Abstract

Introduction Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients’ average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence Level 3.

Management of Lateral Condyle Humeral Fracture Associated With Elbow Dislocation in Children. A Retrospective International Multicenter Cohort Study

“…Complications included elbow stiffness in 4.4% of the patients, nonunion in 1.4%, AVN in 1.4%, malunion in 0.8%, pin tract infections in 0.6%, and growth arrest leading to angular deformity in an additional 0.4%, and early hardware failure in 0.2%. More recently, Eckhoff et al, 27 gathered information on 1299 patients from 13 studies in a systematic review, and found a high rate of union (99.6%), and excellent or good outcomes, as determined by the Hardacre Scale, in 99% of patients.…”

Lateral Humeral Condyle Fractures in Pediatric Patients

“…Lateral overgrowth can be appreciated on conventional radiographs and felt during a physical examination of the elbow [ 10 , 29 ]. The occurrence rate of this complication is comparable between both treatment groups (non-surgical, 4.5–74%; and surgical, 4.5–73.7%) and between surgical techniques (CRPP, 4.5–73.7%; ORIF K-wires, 22.1–73.7%; and ORIF cannulated screw, 10.1–74%) [ 4 , 29 , 34 , 36 , 42 , 49 , 50 , 51 ].…”

“…The authors of each classification system for lateral humeral condyle fractures have made recommendations concerning treatment options based on the severity of the fractures; these recommendations can be found in Table 2 . In cases with a successful fracture union and without complications, the success rate for non-operative and operative lateral humeral condyle fracture, as described in meta-analyses, is between 89.8–91.5% [ 8 , 33 , 35 , 36 ]. A delayed diagnosis of these fractures (>3 weeks after injury) should initially be given based on the time between the injury and presentation and the amount of displacement, in accordance with the above-described options [ 37 , 38 ].…”

“…Surgeons can opt for screw fixation with a small AO bone screw combined with K-wires for rotational stability of the fragment. However, studies show screw fixation results in comparable quality of life and range of motion postoperatively while having disadvantages such as second surgery to remove the screw, impairment of the range of motion, delayed union, and wound infections [ 36 , 43 ].…”

“…Complications can occur during and after treatment. One in ten patients with lateral humeral condyle fractures has severe complications of the fracture and/or treatment [ 8 , 33 , 36 ]. Unsuccessful treatment of this complicated and menacing fracture may lead to a long-term loss in quality of life for pediatric patients.…”