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Closed Reduction and Percutaneous Pinning of Displaced Pediatric Lateral Condyle Fractures of the Humerus

A Cohort Study

Silva, Mauricio MD*,†; Cooper, Shannon D. BS*

doi: 10.1097/BPO.0000000000000376
Trauma Upper Extremity
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Background: In treating pediatric lateral condyle fractures (LCFs) of the humerus, closed reduction and percutaneous pinning (CRPP) is an attractive alternative to open reduction and internal fixation (ORIF) because of the potential decrease in tissue injury, shorter surgical times, and faster functional recovery. However, there is limited information available regarding its outcome.

Methods: The data on 191 pediatric LCFs [163 fractures (85%) treated with ORIF (group 1) and 28 fractures (15%) treated with CRPP (group 2)], who were followed for over 12 weeks, was included in the present analysis. We compared several aspects related to the outcome of CRPP (as compared with ORIF), including issues related to surgical time, recovery of range of motion, lateral spur formation, complications, and overall outcome.

Results: The surgical time was significantly shorter for patients in group 2 (mean: 25.4 min; range: 18 to 50 min), as compared with group 1 (mean: 52.6 min; range: 24 to 121 min). A nearly anatomic reduction (<2 mm of residual displacement) was obtained in all fractures. No intraoperative or immediate postoperative complications were observed. The recovery of range of motion was similar in both groups: during the latest follow-up appointment, elbows in group 1 and 2 had achieved a mean relative arc of motion of 99.2% and 99.7%, respectively (P=0.3). Lateral spur formation was seen in 75% of fractures in group 1 and in 68% of fractures in group 2 (P=0.2). The overall rate of complications was 6.3% and 3.6% for fractures is groups 1 and 2, respectively (P=0.5). A satisfactory outcome was observed in 88.3% of fractures in group 1 and in 89.3% of fractures in group 2 (P=0.6) (Table 1).

Conclusions: CRPP is a viable alternative for the treatment of pediatric LCFs with limited initial displacement (between 2 and 4 mm). In addition to the obvious cosmetic advantage of avoiding an unsightly scar, it is associated with decreased surgical times and does not significantly increase the incidence of complications.

Level of Evidence: Level III.

*Orthopaedic Institute for Children

UCLA/Orthopaedic Hospital Department of Orthopaedics, David Geffen School of Medicine, University of California, Los Angeles, CA

The authors declare no conflicts of interest.

Reprints: Mauricio Silva, MD, Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007. E-mail: msilva@mednet.ucla.edu.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.