Background: Traditionally, the initially non-displaced pediatric humeral
lateral condyle fractures (PHLCFs) were treated conservatively while
displaced or rotated fractures were treated by open reduction and internal
fixation (ORIF). Late displacement and nonunion were reported in some
conservatively treated cases meanwhile, epiphyseal necrosis with or without
non-union and elbow deformity were reported in some cases treated by open
reduction and internal fixation (ORIF). Few studies highlighted closed
reduction and percutaneous fixation (CRPF) for displaced and/or rotated
fractures. The aim of this study is to assess the outcome of closed reduction
and percutaneous fixation for the treatment of pediatric humeral lateral
condyle fractures.
Patients and Methods: A prospective study included 45 cases of pediatric
lateral humeral condyle fractures (PLHCFs) that were pre-operatively
classified according to Song et al classification; all cases were planned to
have percutaneous fixation either in situ pinning if initially non-displaced or
after closed reduction if displaced or rotated. If closed reduction failed,
ORIF was done. The functional results were evaluated according to the
modified Aggarwal et al. criteria.
Results: Closed reduction and percutaneous fixation (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 18.6 ± 3.04 months, ORIF was done in only 8 cases (representing
19.52% of the studied cases) after failed closed reduction. There was a
statistically significant difference (p < 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.
Conclusions: Closed reduction and percutaneous fixation (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. Open
reduction and internal fixation (ORIF) could be restricted only for certain
complex cases or after the failure of CRPF. |
