Background
Traditionally, the initially nondisplaced pediatric humeral lateral condyle fractures were treated conservatively, whereas displaced or rotated fractures were treated by open reduction and internal fixation (ORIF). Late displacement and nonunion were reported in some conservatively treated cases, whereas epiphyseal necrosis with or without nonunion and elbow deformity were reported in some cases treated by ORIF. Few studies have highlighted closed reduction and percutaneous fixation (CRPF) of displaced and/or rotated fractures. The aim of this study is to assess the outcome of CRPF for the treatment of pediatric humeral lateral condyle fractures.
Patients and methods
A prospective study included 45 cases of PHLCFs that were preoperatively classified according to classification by Song and colleagues; all cases were planned to have percutaneous fixation through either in-situ pinning if initially nondisplaced or closed reduction if displaced or rotated. If closed reduction failed, ORIF was done. The functional results were evaluated according to the modified criteria of Aggarwal and colleagues.
Results
CRPF was successful in 80.48% of cases with displaced and/or rotated fractures, with satisfactory clinical and radiological results and no reported surgery-related complications in any case till the last follow-up, with a mean follow-up duration of 18.6±3.04 months. ORIF was done in only eight cases (representing 19.52% of the studied cases) after failed closed reduction. There was a statistically significant difference (<0.001) in the mean radiological union time and the mean time needed for restoration of the full functional capacity of the operated elbow between cases treated by CRPF and cases treated by ORIF.
Conclusion
CRPF could be the treatment of choice for potentially unstable lateral humeral condyle fractures avoiding the complications of late displacement and elbow stiffness reported in some conservatively treated case. CRPF is an efficient and minimally invasive treatment option for some displaced and/or rotated fractures with very satisfactory clinical and radiological results. ORIF could be restricted only for certain complex cases or after the failure of CRPF.