Surgical outcomes in paediatric lateral condyle non-union: A systematic review and meta-analysis

Introduction: Pediatric humeral lateral condyle fractures are the second most common elbow fractures. Their treatment presents challenges due to physeal and intra-articular involvement. Postoperative stiffness is a common concern that can limit limb functionality. This study aims to identify risk factors for postoperative stiffness in a large cohort of these fractures across multiple institutions. Methods: A large, multicenter retrospective review of medical records from 6 level I trauma centers was conducted. Data from children aged 1 to 12 years with lateral condyle fractures treated between 2005 and 2019 were collected. Elbow stiffness was defined in the present study as having a limited elbow ROM that led to requiring a physical or occupational therapy referral or needing surgical treatment to address stiffness. Relevant patient demographics, fracture characteristics, treatment approaches, and complications were analyzed. Results: Six hundred sixty-five fractures were analyzed. The average patient age was 8.8 years with 21% experiencing stiffness. The stiffness group had older patients, a higher incidence of elbow dislocations, a higher rate of open reduction, and more severe fracture patterns. Multivariate regression analysis identified open reduction, increased age, and concurrent elbow dislocation as significant risk factors for stiffness. Patients with stiffness commonly utilized only physical or occupational therapy (96%), while a small percentage (4%) required surgical interventions. Conclusions: This study highlights the risk factors for postoperative stiffness in pediatric humeral lateral condyle fractures, namely increased age, concomitant elbow dislocation, and treatment with open reduction. Families of older patients or severe fracture patterns requiring open reduction and those with concurrent elbow instability should be counseled about their increased risk of stiffness. The authors recommend initially attempting a closed reduction in high-risk patients to help mitigate the risk of postoperative stiffness. Early initiation of range of motion exercises may also be beneficial for at-risk patients. Level of Evidence: Level III: Therapeutic studies—Investigating the results of treatment

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Risk Factors for Stiffness After Surgical Treatment of Pediatric Humeral Lateral Condyle Fractures: Results of a Multicenter Study

Tippabhatla,

Torres-Izquierdo,

Pereira

et al. 2024

“…This will cut off the way on the pathologic remodeling and give the chance for the LHC to regain its participation in the remaining potential growth of the distal humerus. 2,3,5,6,18,19 Good refreshment of the pseudoarthrosis gap until reaching the "Paprika sign" (bleeding raw bone) while avoiding extensive soft tissue dissection of the common extensor origin or stripping of its posterior soft tissue to avoid AVN of LHC is very important. [3][4][5][6][7]15,20,21 Functional reduction is defined as fixing the mobilized LCH fragment with its intact soft tissue vascular pedicle in a position that allows the greatest elbow ROM.…”

Section: Discussionmentioning

confidence: 99%

Long-standing Nonunited Fracture Lateral Humeral Condyle in Children. Evaluating a Two-stage Surgical Treatment Strategy With Critical Review

Khanfour

2024

Objective: This work aimed to evaluate the results of using a 2-stage surgical treatment strategy without doing anterior transposition of the ulnar nerve (ATUN) for cases with long-standing nonunited fracture lateral humeral condyle (LHC) in children, accompanied by a critical review. Methods: A consecutive 12 children with a long-standing “>2 years” nonunited LHC with evident radiologic gross anatomic distortion of the elbow were included in this study. A 2-stage surgical treatment strategy was applied, wherein the first stage, open functional reduction, osteosynthesis, and iliac bone graft were done. Then after 6 months, the second stage surgery was carried out in the form of supracondylar humeral corrective osteotomy if the cubitus valgus angle was ≥20 degrees. ATUN was not done for any of the cases even with those having ulnar nerve dysfunction. Results: Union took place in 11 out of the 12 cases after a mean follow-up period of 11 weeks (range: 8 to 14 wk; SD: 1.6). All the 7 cases showed preoperative ulnar nerve dysfunction and reported clinical recovery at the end of their follow-up. Conclusions: Two-stage surgical treatment strategy without ATUN is a convenient, reproducible, and successful line of treatment for children presented with longstanding nonunited LHC with anatomically distorted elbow. Level of Evidence: Level IV—case series.

“…Fracture nonunions are a well-documented complication associated with lateral condyle fractures. 15,29,30 Given the biomechanical strength afforded by screw fixation, 1 argument in favor of the screw technique is a greater likelihood of fracture union. 21 The findings of Ganeshalingam et al are consistent with this theory.…”

Section: Discussionmentioning

confidence: 99%

“…Another difference between the study by Ganeshalingam et al and this study is nonunion rates. Fracture nonunions are a well-documented complication associated with lateral condyle fractures 15,29,30. Given the biomechanical strength afforded by screw fixation, 1 argument in favor of the screw technique is a greater likelihood of fracture union 21.…”

Section: Discussionmentioning

confidence: 99%

K-wire Versus Screw Fixation in Displaced Lateral Condyle Fractures of the Humerus in Children: A Multicenter Study of 762 Fractures

Cummings

Schwabe

Rivera

et al. 2023

Introduction: Lateral humeral condyle fractures account for 12% to 20% of all distal humerus fractures in the pediatric population. When surgery is indicated, fixation may be achieved with either Kirschner-wires or screws. The literature comparing the outcomes of these 2 different fixation methods is currently limited. The purpose of this study is to compare both the complication and union rates of these 2 forms of operative treatment in a multicenter cohort of children with lateral humeral condyle fractures. Methods: This retrospective study was performed across 6 different institutions. Data were retrospectively collected preoperatively and 6 weeks, 3, 6, and 12 months postoperatively. Patients were divided into 2 cohorts based on the type of initial treatment: K-wire fixation and screw fixation. Statistical comparisons between these 2 cohorts were performed with an alpha of 0.05. Results: There were 762 patients included in this study, 72.6% (n=553) of which were treated with K-wire fixation. The mean duration of immobilization was 5 weeks in both cohorts, and most patients in this study demonstrated radiographic healing by 11 weeks postoperatively, regardless of treatment method. Similar reoperation rates were seen among those treated with K-wires and screws (5.6% vs. 4.3%, P=0.473). Elbow stiffness requiring further intervention with physical therapy was significantly more common in those treated with K-wires compared with children treated with screws (21.2% vs. 13.9%, P=0.023) as was superficial skin infection (3.8% vs. 0%, P=0.002), but there was no significant difference in nonunion rates between the two groups (2.4% vs. 1.3%, P=1.000). Conclusion: We found similar success rates between K-wire and screw fixation in this patient population. Contrary to previous studies, we did not find evidence that treatment with screw fixation decreases the likelihood of experiencing nonunion. However, given the unique complications associated with K-wire fixation, such as elbow stiffness and superficial skin infection, the treatment with screw fixation remains a reasonable alternative to K-wire fixation in these patients. Level of Evidence: Level III—retrospective comparative study