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Surgical treatment of displaced pediatric lateral condyle fractures of the humerus by the posterior approach

Conaway, William, K.a; Hennrikus, William, L.a; Ravanbakhsh, Samineb; Winthrop, Zacharya; Mahajan, Johnc

Journal of Pediatric Orthopaedics B: March 2018 - Volume 27 - Issue 2 - p 128–133
doi: 10.1097/BPB.0000000000000481
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The surgical approach for open reduction and internal fixation of lateral condyle fractures in children is controversial. Some authors recommend the lateral approach to the elbow over the posterior approach because of theoretical concern for injury to the vascular supply of the distal humerus and potential avascular necrosis (AVN). The purpose of this retrospective case series study is to report the outcomes of open reduction and internal fixation of displaced lateral condyle fractures of the humerus by the posterior approach. Fifteen consecutive cases were reviewed and the posterior approach resulted in minimal postoperative loss of motion, no angular deformity, cosmetic scars, and no AVN. We support that AVN occurs because of stripping of soft tissues from the lateral condyle fragment and not the approach used. Stripping of soft tissues is not required when using the posterior approach because of excellent visualization of the fracture reduction.

aDepartment of Orthopaedics, Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania

bDepartment of General Surgery, Kaiser Permanente Los Angeles Medical Center, University of California Los Angeles, Los Angeles

cDepartment of Orthopaedics, St Mary’s Medical Center, David Geffen School of Medicine, San Francisco, California, USA

Correspondence to William K. Conaway, BA, 500 University Drive, Hershey, PA 17033, USA Tel: +1 401 954 7689; fax: +1 717 531 7120; e-mail: wconaway@hmc.psu.edu

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