Delayed Operative Management of Fractures of the Lateral Condyle of the Humerus in Children

Comparative Outcomes of Early, Elective, and Delayed Treatment for Lateral Condyle Fracture of the Humerus in Children: A Retrospective Study from a Single Center in Turkey (2013-2021)

BACKGROUND Lateral condyle fracture of the humerus in children should be diagnosed and treated quickly to avoid the complications of malunion and varus deformity of the elbow. Worldwide, pediatric orthopedic departments experienced delays in patient diagnosis and treatment during the COVID-19 pandemic. This retrospective study from a single center in Turkey aimed to compare outcomes from early treatment, elective treatment, and delayed treatment in 140 children with lateral condyle fracture of the humerus between 2013 and 2021. MATERIAL AND METHODS In the study, 140 patients with Milch type 2 fractures were included. Patients underwent fixation with K-wires or screws after open or closed reduction. Data collected included age, sex, trauma details, surgery timing, operating conditions, perioperative issues, and rehabilitation outcomes. Fracture union and complications were monitored through clinical examinations and X-rays. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS). RESULTS There were 58 patients in the early group, 52 in the elective group, and 30 in the delayed group. Surgery durations varied among the groups (P=0.000). The early and delayed groups as well as the early and elective groups had significantly different incision sizes (P=0.000 for both). The early and delayed groups and the early and elective groups had significantly different MEPS scores (P=0.002 and P=0.011, respectively). CONCLUSIONS In patients with late-presenting lateral condyle fractures, although complications increase, surgical treatment does not yield worse outcomes. Standardization of fracture management should be maintained during periods such as COVID-19.

Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study

BACKGROUND

The purpose of this study was to investigate the clinical and functional outcomes of early versus delayed treatment of pediatric lateral condylar fractures of the humerus with a displacement greater than 2 mm.

METHODS

Sixty-seven children treated surgically at our hospital from March 2016 to September 2021 for lateral condylar fracture of the humerus with displacement > 2 mm were retrospectively analyzed. The children were divided into two groups where early surgery consisted of patients being operated on within 24-h post-injury (n = 36) and delayed surgery consisted of children operated after 24-h post-injury (n = 31). Clinical and functional results were compared between the two groups.

RESULTS

There were no significant differences between the two groups in terms of operation time, blood loss and incidences of perioperative complications. However, mean length of incision was significantly greater (P < 0.0001) in the delayed treatment group (5.68 ± 1.08 cm) compared to the early treatment group (3.89 ± 0.82 cm). No differences were found in functional outcomes, consisting of the Baumann angle of the affected limb, the carrying angle, Mayo Elbow Performance Score, and Flynn's criteria at final follow-up.

CONCLUSIONS

Delay in surgery for more than 24 h after injury does not influence the clinical and functional results for lateral condylar fracture of the humerus with displacement > 2 mm in children. However, delayed open reduction and pinning may increase the incision length possibly due to increased edema.

Open reduction versus in-situ fixation of neglected lateral condyle fractures: a comparative study

The management of neglected fracture of the lateral condyle of the humerus is controversial. Careful neglect and conservative management with early ulnar nerve transposition and ostetomy, in-situ surgical fixation and accurate open reduction and internal fixation are all recommended as treatment options. However, an overgrowth of fractured condyle, highly distorted anatomy, contracted soft tissue and almost unrecognizable fracture ends make open reduction a challenging task. As the functional loss is not severe, in-situ fixation of the fragment provides a good alternative. There have been proponents of both surgeries with very limited data on comparison on both procedures. Here, we present our experience of 45 patients, 22 treated with anatomical reduction and 23 treated with in-situ fixation with no attempts of anatomical restoration, and attempted to evaluate the results of two surgeries with a follow-up of at least 2 years. Neglected fractures of the lateral condyle were surgically treated with two different techniques. In all, 22 patients were treated with open reduction and fixation whereas 23 patients were treated with in-situ fixation to render the elbow stable. Patients were followed for a minimum of 2 years. These patients were studied in terms of functional scores and radiological union. Radiological union was better in the anatomical reduction group with one nonunion compared with five in the in-situ group. However, functional results and elbow range were better in the in-situ fixation group. The surgical time was 57 min in in-situ fixation compared with 73 min in the anatomical reduction group. Complication rates were found to be high in the open reduction group. In-situ fixation of neglected lateral condyle fractures is an effective technique for the treatment of these difficult fractures presenting late compared with anatomical fixation. Radiological union, although less successful compared with open anatomical reduction, leads to better functional outcome, with decreased surgical time and postoperative complications.

Operative Management of Late Presented Displaced Lateral Condyle Fracture of Humerus in Children

INTRODUCTION

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children.

METHODS

We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria.

RESULTS

We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united.

CONCLUSIONS

Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.