This article assesses the clinical and radiographic results of lateral condylar fractures of the distal humerus in children. The study is the largest series to investigate lateral condylar fractures and includes both conservatively and operatively treated cases by a single surgeon. The authors carefully assessed the outcome of 175 patients followed for more than one year. They especially looked at complications including varus, valgus, lateral overgrowth, fishtail deformity, nonunion, malunion, and avascular necrosis.
The initial cohort consisted of 195 patients, but 17 were excluded for a variety of reasons. Of these 175 cases, 39 were treated by long armed cast immobilization, 33 by closed reduction and internal fixation and 103 by open reduction and internal fixation. Fixation was accomplished with Kirschner wires and screws and a long arm cast was applied for 5 to 6 weeks. Subsequently, the cast was removed and range of motion exercises instituted.
The results indicate that the fractures were primarily Type I in 18 cases and 157 cases were Type II according to the Milch classification. A cast was applied for about 5 weeks duration, and surgery was done about 4 days after injury. The clinical results show no cases of avascular necrosis, fishtail deformity, nonunion, or limited range of motion. There were 11 cases of superficial infection treated by pin removal and oral antibiotics. There were a few cases of delayed unions and 3 cases of valgus deformity owing to partial growth arrest. The most common problem encountered in 39 or 22% of the patients was a lateral condylar overgrowth of distal humerus creating a varus deformity. None of these patients required surgery. The incidence of lateral prominence was greater in those children requiring open reduction and internal fixation.
This study highlights the treatment of lateral condylar fractures. There is no doubt that astute diagnosis and appropriate treatment leads to exceptional results. All patients regained normal range of motion compared to the contralateral side. The most common complication was varus deformity attributed to lateral condylar overgrowth, which is unlikely related to surgery. In essence, the authors should be commended for their appropriate diagnosis and treatment of this fracture. Prompt recognition and proper treatment uniformly results in an outstanding outcome.