Closed reduction and internal fixation of completely displaced and rotated lateral condyle fractures of the humerus in children.
OBJECTIVE
To determine the usefulness of closed reduction and internal fixation as the initial treatment for completely displaced and rotated fractures of the lateral condyle of the humerus in children.


METHODS
Prospective.


METHODS
Three Level I trauma centers.


METHODS
We prospectively studied 24 consecutive completely displaced and rotated lateral condylar fractures of the humerus in children (Jakob Stage 3, 20 boys and four girls) that were treated by three different surgeons working at different hospitals during the same period.


METHODS
In 21 fractures, we initially attempted closed reduction and internal fixation; in three, we used open reduction and internal fixation and made no attempt at closed reduction.


METHODS
We assessed the preoperative degree of displacement and postoperative radiographic quality of closed reduction. Clinical results were graded using the criteria suggested by Hardacre et al.


RESULTS
Eighteen of 24 (75%) completely displaced and rotated fractures were reduced within 2 mm of residual displacement using the closed method. Three fractures were treated with open reduction and internal fixation initially and internal fixation because of one surgeon's lack of confidence in closed reduction, because of lack of experience with it, early in the study period. Closed reduction to within 2 mm failed in three fractures, so open reduction and internal fixation was then performed. There were no significant complications such as limited range of motion, pain, osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest.


CONCLUSIONS
Closed reduction and internal fixation is an effective treatment for completely displaced and rotated lateral condyle fractures of the humerus in many children.
Song
Kwang Soon
KS
Department of Orthopedic Surgery, Keimyung University, Daegu, Korea. skspos@dsmc.or.kr
Shin
Yong Woon
YW
Oh
Chang Wug
CW
Bae
Ki Choer
KC
Cho
Chul Hyun
CH
D002648:Child; D002675:Child, Preschool; D004550:Elbow / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries