Clinical and radiographic results of lateral condylar fracture of distal humerus in children

Abstract

Background: The treatment goal in lateral condylar fracture is union without residual deformity. However, growth disturbance may occur despite initial anatomic reduction and secure fixation. The purpose of this study was to evaluate the clinical and functional results, including complications, of lateral condylar fracture treatments in children, and to identify differences between treatment methods.

Methods: One hundred seventy-five patients followed for more than a year with available initial and final follow-up radiographs were included. Carrying angle and range of motion limitations were assessed, and functional results were evaluated using the scoring system devised by Dhillon et al. All complications including varus, valgus, lateral overgrowth, fishtail deformity, nonunion, malunion, and avascular necrosis were investigated statistically.

Results: There were 113 male and 62 female of mean age 4 years 9 months. Thirty-nine patients were managed by cast immobilization. Closed reduction and internal fixation (CRIF) was carried out in 33 and open reduction and internal fixation (ORIF) in 103. Kirschner wires were removed at a mean 5.5 weeks. There were 11 superficial infections, 3 valgus, 3 delayed unions. In 135 (77.1%) of the 175 patients, obvious lateral condylar overgrowths were observed at 19.8 (+/-16.8) months (range, 12 to 120) without evidence of a functional abnormality. Development of lateral elbow prominence revealed difference between the 3 treatment methods and it was caused by the difference between cast and ORIF (1 vs. 32, P<0.001). It also showed difference between the 3 fracture types and it was caused by significant difference between type I and II (1 vs. 24) and between I and III (1 vs. 14) (P<0.001, respectively). Mean radiographic carrying angles showed a decrease of 5.0 (+/-4.6) degrees at final follow-ups, but no significant difference was observed between fracture types or treatment method (P=0.832 and 0.850, respectively). Clinically, 17 cases (9.7%) with varus deformities were observed, although there was no need for corrective surgery. At final follow-ups, 116 patients had achieved an excellent result and 59 a good result.

Conclusion: This study shows that bone union and good clinical results can be achieved in children with a lateral condylar fracture, and that lateral overgrowth and cubitus varus are the most common residual deformities. Furthermore, these residual deformities were not remodeled at a mean 19.8 months after injury.

Level of evidence: Case series, Level IV.