Open reduction versus in-situ fixation of neglected lateral condyle fractures: a comparative study

The management of neglected fracture of the lateral condyle of the humerus is controversial. Careful neglect and conservative management with early ulnar nerve transposition and ostetomy, in-situ surgical fixation and accurate open reduction and internal fixation are all recommended as treatment options. However, an overgrowth of fractured condyle, highly distorted anatomy, contracted soft tissue and almost unrecognizable fracture ends make open reduction a challenging task. As the functional loss is not severe, in-situ fixation of the fragment provides a good alternative. There have been proponents of both surgeries with very limited data on comparison on both procedures. Here, we present our experience of 45 patients, 22 treated with anatomical reduction and 23 treated with in-situ fixation with no attempts of anatomical restoration, and attempted to evaluate the results of two surgeries with a follow-up of at least 2 years. Neglected fractures of the lateral condyle were surgically treated with two different techniques. In all, 22 patients were treated with open reduction and fixation whereas 23 patients were treated with in-situ fixation to render the elbow stable. Patients were followed for a minimum of 2 years. These patients were studied in terms of functional scores and radiological union. Radiological union was better in the anatomical reduction group with one nonunion compared with five in the in-situ group. However, functional results and elbow range were better in the in-situ fixation group. The surgical time was 57 min in in-situ fixation compared with 73 min in the anatomical reduction group. Complication rates were found to be high in the open reduction group. In-situ fixation of neglected lateral condyle fractures is an effective technique for the treatment of these difficult fractures presenting late compared with anatomical fixation. Radiological union, although less successful compared with open anatomical reduction, leads to better functional outcome, with decreased surgical time and postoperative complications.