Open Vs. Closed Reduction in Type 2 Lateral Condyle Fractures

Lateral condyle fractures are associated with high morbidity due to their risk of nonunion and avascular necrosis (AVN). This study aims to assess the outcomes between closed reduction and the more traditional open techniques for operative fractures.

All lateral condyle fractures that required operative fixation (pins or screws) over a ten-year period were included. We compared open versus closed reduction for OR time, infection rate, AVN, nonunion, premature physeal closure, ulnohumeral angle, and interepicondylar width (IEW).

28 patients were identified in the closed reduction group while 41 were identified in the open reduction group. Average displacement at surgery for these two groups was significantly different at 3.95mm for the closed group and 9.47mm for the open group (p<0.0001). Operating room time was significantly greater for the open reduction group by an average of 45 minutes (p <0.0001). Additionally, the closed reduction group was significantly less likely to require postoperative admission compared to the open reduction group (p=0.0004). There were no significant differences between the two groups with regard to abnormal ulnohumeral angles, infection rates, avascular necrosis, nonunion, lateral spur formation, premature physeal closure, or reoperation rate.

The significant differences in OR time and post-operative admission make closed reduction the preferred approach from a hospital system quality improvement standpoint.Level of Evidence: IV.