Displaced lateral humeral condylar fractures in children : better prognosis with early diagnosis, open reduction, and internal fixation

Abstract EN

Objective: The aim of this study was to evaluate the outcome of the various management techniques for displaced lateral humeral condylar fractures in children in order to reduce complications.

Methods: This is a retrospective study of 72 patients who were treated for fractures of displaced lateral condyle of the humerus between 1996 and 2002 at King Hussein Medical Center, Amman, with an average follow up of 26 months (range between 8-42 months).

Forty three patients were treated by open reduction and internal fixation using 2 Kirschner wires 4.0 mm in diameter; 9 patients were treated by percutaneous pinning; 12 patients were treated by closed reduction and posterior slab; and 8 patients were misdiagnosed at the time of injury by the initial emergency surgeon.

Results: Forty-nine patients (68%) were males and 23 (32%) were females.

Ages ranged between 2-10 years.

The right side was affected in 33 cases; the left side was affected in 39 cases.

Forty-two patients who were treated with Kirschner wires and open reduction and internal fixation had satisfactory outcome and full range of elbow movements; only one patient lost 10 degrees of extension.

Only three patients with percutaneous pinning achieved satisfactory results.

Nine of the 12 patients who were treated conservatively by closed reduction developed complications.

The 8 cases that were misdiagnosed at time of injury all developed complications.

Conclusion : Open reduction and internal fixation must be performed in all displaced lateral humeral condylar fractures in children in order to avoid complications.

Percutaneous K-wire pinning must be reserved for undisplaced fractures.

More concentration both clinically and radiologically on elbow injuries is required to avoid missing lateral humeral condylar fractures.