Pediactric Lateral Condyle Fracture – should we Change Management Protocol?

Introduction: Lateral condyle fractures are intra articular fractures, with a well documented problem of under diagnosis of the intra articular involvement of the fracture, due to its cartilaginous properties. Treatment of these fractures maybe of POP and close follow up, closed reduction and pinning (CRPP) or open reduction internal fixation (CRIF).

Purpose of Study: To examine the clinical outcomes of our current treatment protocol.

Methods: A retrospective study. All pediatric patients, who underwent any surgical intervention for a lateral condyle fracture between January 1^st 2008 and June 30^th 2017 were included in the study.

Exclusion criteria were: previous deformity of the distal humerus and lack of data regarding the primary fracture type.

The primary fracture type was classified as nondisplaced (type 1), minimally displaced,

Results: We had111 children surgically treated for lateral condyle fractures during this time period. 107 met inclusion criteria. 27 patients were treated by CRPP and 79 by ORIF. 1 patient was treated with CRPP, and later converted to ORIF.

Of the patients treated by CRPP, 25 were type 2 fractures, and 2 were type 3. Of the patients treated by ORIF, 2 were initially diagnosed as type 1 fractures, but had secondary displacement at follow up; 10 were type 2, and 67 were type 3 fractures. In 10 of these type 3 patients, a closed reduction was attempted, but unsuccessful.

In the CRPP group, one patient had a secondary displacement, which was treated with an ORIF. This patient developed a pin tract infection.

In the ORIF group, we had 1 pin tract infection, 2 Avascular necrosis, and 1 late cubitus varus.

All patients had good functional results.

Conclusions:

Our results suggest that treating type 1 fractures with POP and once a week follow up, treating type 2 fractures with CRPP when possible, and treating type 3 fractures with ORIF, will have good functional results and low complication rates.