Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation for Type II Lateral Condyle Humerus Fractures in Children Displaced >2 mm.

BACKGROUND: The optimal treatment for pediatric lateral condyle fractures displaced >2 mm, but with little joint displacement is unclear. The purpose of this study was to assess clinical and radiographic outcomes and complication rates of patients undergoing open reduction internal fixation (ORIF) versus closed reduction and percutaneous pin fixation (CRPP) of lateral condyle fractures with >2 mm of displacement and no obvious articular surface incongruity.

METHODS: A retrospective review of all children with acute lateral condyle fractures with 2.1 to 5.0 mm of displacement treated from 2006 to 2014 was performed. A total of 74 patients were treated who met inclusion criteria; 51 underwent ORIF and 23 underwent CRPP. No differences existed between the 2 groups with respect to age, sex, extremity, mechanism of injury, time to treatment, fracture displacement, or fracture classification. Charts and radiographs were reviewed and the following parameters were documented: operating room time, time to union, return to activities, magnitude of lateral spurring, and complications. Major complications were defined as those with presumptive long-term effects or requiring reoperation.

RESULTS: All fractures healed within 12 weeks of surgery, regardless of treatment type and no differences were observed in time to union between groups. OR time averaged 30 minutes faster for the CRPP group (P<0.001). Nearly 10% of patients in each group developed elbow stiffness, requiring formal therapy. The overall complication rates were 25% for the ORIF group and 13% for the CRPP group (P=0.36). No major complications were observed in the CRPP group, whereas 3 (6%) were observed in the ORIF group, including 1 case of avascular necrosis, 1 case of osteomyelitis with an associated premature physeal closure, and 1 refracture requiring surgery.

CONCLUSIONS: Surgical treatment of lateral condyle fractures displaced >2 mm, but with no significant articular surface incongruity has good outcomes with both CRPP and ORIF. CRPP, however, minimizes surgical time, avoids an incision and is thus our preferred treatment approach when joint congruity can be confirmed.

LEVEL OF EVIDENCE: Level III-therapeutic study.