Current Concepts in the Treatment of Lateral Condyle Fractures in Children

Joshua M. Abzug, MD; Karan Dua, MD; Scott H. Kozin, MD; Martin J. Herman, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(1):e9-e19. 

In This Article

Surgical Management

Indications

Surgical management includes both closed reduction with fixation and ORIF as options. Because the foremost goal of surgical treatment is to restore the articular surface anatomically, the choice of procedure is ideally based on minimizing the extent of surgery but not compromising the reduction of the fracture. There is little controversy that fragment displacement >2 mm and an incongruent articular surface are the primary indications for surgery.[4,5,9] Other relative indications for surgical management include unstable fractures, as documented by progressive displacement on serial radiographs, and patients who fail nonsurgical treatment for reasons such as delayed fracture healing or the inability to maintain or tolerate casting, a scenario seen occasionally in very young or obese patients.

Closed Reduction With Fixation

This technique is most commonly used for displaced fractures with an intact cartilage hinge or no notable fragment malrotation, such as Weiss type 2 and Song stage 2 to 4 injuries, and nondisplaced fractures that subsequently displace after cast immobilization.[4,5] It is critical that, after closed reduction, the fracture is reduced with <2 mm of displacement,[4] anatomic articular surface restoration is achieved, and that this alignment is confirmed with intraoperative fluoroscopic imaging, which can be assisted by arthrography. Weiss et al[5] observed that fractures displaced >2 mm but <4 mm were likely to be successfully reduced closed. Stable fixation is then performed after closed reduction.

ORIF

Treatment of Weiss type 3 and Song type 5 fractures, that is, those with notable initial displacement and associated fracture fragment malrotation, are best treated with ORIF.[4,5,16] In addition, ORIF is indicated for all fractures that fail an attempted closed reduction and in cases in which acceptable reduction cannot be confirmed by arthrography with certainty. Weiss et al[5] importantly noted that all type 3 fractures in their series had ≥4 mm of initial displacement and were treated with ORIF, as opposed to CRPP, to restore the articular surface anatomically.

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