title: Recovery of elbow motion following pediatric lateral condylar fractures of the humerus.
abstract: BACKGROUND
  Temporary elbow stiffness is often seen after a lateral condylar fracture of the distal end of the humerus in children. There are scant scientific data available to assess the expected time frame for return of elbow motion after these injuries. The purpose of this study is to provide a prospective, longitudinal evaluation of elbow motion in a large group of pediatric patients undergoing treatment for a lateral condylar fracture of the distal end of the humerus.
  
  
  METHODS
  We prospectively evaluated 141 patients with lateral humeral condylar fractures at a mean age of 5.2 years and with a mean follow-up of twenty-nine weeks. The patients were treated with cast immobilization, percutaneous pinning, or open reduction and internal fixation on the basis of the initial displacement. Elbow motion was followed longitudinally at clinic visits. Relative arc of motion was calculated as a percentage of the motion of the normal, contralateral elbow.
  
  
  RESULTS
  The mean relative arc of motion at the time of cast removal was 44%, reaching 84% by week 12. By weeks 18, 24, 36, and 48, the relative arc of motion reached 87%, 90%, 93%, and 97%, respectively. Compared with fractures treated without surgery, those treated surgically had a significantly lower absolute arc of motion from the time of cast removal (p = 0.018) and up to eighteen weeks after the injury (p < 0.001); however, no significant difference was observed at eighteen weeks or beyond. For patients treated surgically, no significant difference in relative arc of motion was observed between the patients with closed or open reductions. The age of the patient (hazard ratio = 0.87, p = 0.008), length of immobilization (hazard ratio = 0.79, p = 0.03), and severity of the fracture (hazard ratio = 0.40, p < 0.0001) were independent predictors of recovery of elbow motion after a lateral humeral condylar fracture in children.
  
  
  CONCLUSIONS
  An initial rapid recovery in elbow motion can be expected after a lateral humeral condylar fracture in a child, with progressive improvements for up to one year after the injury. This recovery is slower if the patient is older, has a longer period of immobilization, and has a more severe injury.
authors.affiliation: Department of Orthopaedics, UCLA Orthopaedic Hospital, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 16-155 CHS, Los Angeles, CA 90095.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Bernthal
authors.forename: C Max
authors.initials: CM
authors.lastname: Hoshino
authors.forename: Daniel
authors.initials: D
authors.lastname: Dichter
authors.forename: Melissa
authors.initials: M
authors.lastname: Wong
authors.forename: Mauricio
authors.initials: M
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function