Closed and Open Reduction of Displaced Pediatric Lateral Condyle Humeral Fractures, a Study of Short-Term Complications and Postoperative Protocols

Abstract

Background: Displaced lateral condyle humeral fractures in children are treated operatively to maximize function and growth of the elbow. Traditionally an open approach is used for reduction of the fracture, but recent series have shown promising results with closed reduction. Percutaneous pins are typically used for fixation, no matter the reduction method. This retrospective review compares our experience with early complications after open and closed reduction of these fractures.

Methods: We retrospectively reviewed charts and radiographs of operatively treated lateral condyle fractures. The Song and Jakob classification systems were utilized to determine fracture severity. High-grade displacement was defined as Song stage 4 and 5, or Jakob type 3. Data was analyzed by fracture type (high-grade or low-grade) and by treatment method to look for differences in complication rates and treatment differences. Complications were defined as delayed union and infection.

Results: 172 fractures were analyzed, 141 were treated open, and 31 were treated closed. There were no statistically significant differences in pin duration, total cast time, additional procedures, or short term complications between the open and closed treatment groups, or the high and low-grade fracture groups. High-grade fractures were more likely to be treated with open reduction (p<0.0001). Pin duration prior to removal was not associated with increased incidence of infection or delayed union.

Conclusions: Closed reduction and percutaneous pinning of lateral condyle fractures amenable to this treatment does not seem to require any changes in postoperative treatment or alter the incidence of early complications when compared to open procedures.

Level of evidence: IV.

Figures

Figure 1a

– Anteroposterior view of a displaced and rotated lateral condyle humerus fracture.

Figure 1b

– Intraoperative arthrogram following closed reduction and percutaneous pinning of the fracture depicted in Figure 1a.

Figure 1c

– Follow-up anteroposterior view of the healed fracture from Figures 1a and 1b.

Figure 2a

– Anteroposterior view of lateral condyle fracture

Figure 2b

– Internal oblique view of the lateral condyle fracture depicted in figure 2a allowing improved visualization of the degree of displacement