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Percutaneous Screw Fixation Promotes Healing of Lateral Condyle Nonunion in Children

Knight, Dominique M. FRCS(Tr&Orth), MBBS, MRCS, BSc; Alves, Cristina MD, FEBOT; Alman, Benjamin MD, FRCSC; Howard, Andrew MD, MSC, FRCSC

Journal of Pediatric Orthopaedics: March 2014 - Volume 34 - Issue 2 - p 155–160
doi: 10.1097/BPO.0000000000000077
Upper Extremity

Background: This retrospective study examined whether pediatric lateral condyle nonunions could be successfully managed by percutaneous screw fixation. We report the outcome of this minimally invasive technique avoiding open reduction and bone grafting associated with the risk of avascular necrosis (AVN), infection, and stiffness.

Methods: The hospital radiology database was searched between 1998 and 2008. This identified 16 consecutive patients aged 2 to 10 years, with lateral condyle nonunions treated with percutaneous screw fixation. We assessed clinical and radiographic outcomes from presentation to final follow-up. Potential risk factors for recalcitrant nonunion were identified. Categorical variables are presented as proportions and percentages. Continuous variables were assessed for normality with the d’Agostino-Pearson test. Normally distributed variables are presented as means with 1 SD. Non-normally distributed data are presented as medians with interquartile range.

Results: Outcome was defined as successful if radiologic and clinical union was achieved. Twelve patients (75%) united after surgery, at a mean of 16.2 weeks (±6.74). Four (25%) failed to unite. The failures presented with nonunion later (median of 225.5 wk from initial injury). This was significantly different (P=0.039) from presentation in the successful group (median time 15.7 wk).

Median age at injury was 5.1 years (range, 3.2 to 7.2) in the successful and 2.8 years (range, 2.1 to 4.7) in the unsuccessful group (P=0.18). Overall, mean time from nonunion diagnosis to percutaneous surgery was 5.2 weeks (±4.11). Forty-four percent had implant removal once union was achieved and no cases of AVN were reported.

Conclusions: We demonstrate this technique to be successful in nonunions addressed within 16 weeks from initial injury to diagnosis. Our 4 failures occurred in nonunions diagnosed >31 weeks from the injury (31, 68, 383, 427 wk). All had been managed nonoperatively as their primary treatment plan.

Percutaneous fixation is feasible and safe. Patients not achieving union were diagnosed after a greater delay. There was a trend toward successfully treated patients being younger. There were no cases of AVN, infection, or elbow stiffness.

Level of Evidence: Level 4.

Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada

The authors declare no conflict of interest.

Reprints: Dominique M. Knight, FRCS(Tr&Orth), MBBS, MRCS, BSc, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol, UK BS2 8BJ. E-mail:

© 2014 by Lippincott Williams & Wilkins