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Prospective Evaluation of a Treatment Protocol Based on Fracture Displacement for Pediatric Lateral Condyle Humerus
Alexander Nazareth1, Curtis D VandenBerg1, Natalya Sarkisova1
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
This study validates a displacement-based classification for pediatric lateral condyle fractures, showing excellent functional outcomes regardless of fracture type when displacement guides treatment.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Lateral condyle fractures are common in children.
- Current treatment protocols vary, lacking a standardized approach based on fracture displacement.
- A displacement-based classification system is proposed to guide treatment decisions.
Purpose of the Study:
- To prospectively evaluate a displacement-based classification system for pediatric lateral condyle fractures.
- To assess an outcome-derived algorithm in guiding treatment.
- To correlate fracture displacement with functional outcomes.
Main Methods:
- Prospective enrollment of pediatric patients with lateral condyle fractures (2013-2016).
- Classification and treatment based on displacement: Type I (<2mm), Type II (2-4mm), Type III (>4mm).
- Functional outcomes assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) at 6-12 weeks and 1-year follow-up.
Main Results:
- 55 children (mean age 6 years) were enrolled.
- Treatment distribution: Type I (31%), Type II (15%), Type III (54%).
- Complications included delayed union (6-10%) and pin site infections (3%). No significant difference in outcomes across fracture types was observed.
Conclusions:
- The displacement-based classification system effectively guides treatment for pediatric lateral condyle fractures.
- Excellent functional outcomes are achievable across all fracture types.
- Radiographic fracture displacement is a reliable guide for surgical and clinical decision-making.
Background:
To prospectively evaluate a displacement-based classification system and an outcome-derived algorithm in the treatment of children with lateral condyle fractures.
Methods:
All children with a lateral condyle fracture were prospectively enrolled at our institution between 2013 and 2016. Fractures were classified and treated on the basis of the following classification system: type 1: <2 mm; treated with long arm casting, type II: 2 to 4 mm; treated with closed reduction and percutaneous pinning (CRPP), and type III: >4 mm; open reduction and percutaneous pinning (ORPP). Functional outcomes were assessed at 6 to 12 weeks and at 1-year follow-ups using the Pediatric Outcomes Data Collection Instrument (PODCI).
Results:
A total of 55 patients (mean age, 6 y; range 2 to 12 y) were prospectively enrolled. There were 17 (31%) type I fractures treated with a long arm cast, 8 (15%) type II treated with CRPP, and 30 (54%) type III treated with ORPP. Postoperative complications included delayed union (N=5) and pin site infection (N=3). Delayed unions on the basis of fracture type was type I (1/17, 6%), type II (1/8, 13%), and type III (3/30, 10%) (P=0.85). The rate of delayed unions in type II and III fractures fixed with k-wires was 11% (4/38). Four patients required a second operation with screw fixation. No significant differences were found across PODCI domains at 1-year follow-up when comparing our study population with normative data.
Conclusions:
This is the first prospective study of a treatment protocol for pediatric lateral condyle fractures and validates the use of displacement as a guide for best evidence-based treatment. Children with a lateral condyle fracture can achieve excellent functional outcomes in all classification types with comparable complication rates when radiographic fracture displacement is used to guide surgical and clinical decision making.
Level Of Evidence:
Level II.
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