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Closed Reduction Techniques Are Associated With Fewer Complications Than Open Reductions in Treating Moderately
Abhishek Tippabhatla1, Beltran Torres-Izquierdo1, Daniel E Pereira2
1Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO.
Insights
Closed reduction for pediatric lateral humeral condyle fractures is linked to fewer complications. This study suggests attempting closed reduction first for moderately displaced fractures to improve patient outcomes.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Skeletal Biology
Background:
- Lateral humeral condyle (LC) fractures are common pediatric elbow injuries.
- Traditionally, open reduction was standard for displaced fractures, but closed reduction shows promise.
- This study compares outcomes of open versus closed reduction for specific pediatric LC fractures.
Purpose of the Study:
- To compare the efficacy of open reduction versus closed reduction for treating pediatric lateral humeral condyle fractures.
- To evaluate complication rates, including delayed healing and stiffness, between the two treatment methods.
- To provide evidence-based recommendations for the optimal management of these fractures.
Main Methods:
- Retrospective analysis of 480 pediatric patients (1-12 years) with Song classification types 1-4 LC fractures.
- Data collected from 6 level 1 trauma centers (2005-2019).
- Propensity score matching used to compare outcomes between closed reduction (CR) and open reduction (OR) groups.
Main Results:
- Open reduction (58%) was more common than closed reduction (42%).
- The open reduction group had significantly higher rates of delayed healing (52% vs. 28%) and elbow stiffness (22% vs. 10%).
- No significant differences in infection or nonunion rates were observed between groups.
Conclusions:
- Moderately displaced lateral humeral condyle fractures treated with open reduction have increased risks of stiffness and delayed healing.
- Closed reduction techniques should be considered the primary treatment for these fractures when anatomic reduction is achievable.
- Prioritizing closed reduction can lead to better patient outcomes in pediatric lateral humeral condyle fractures.
Introduction:
Lateral humeral condyle (LC) fractures are the second most common pediatric elbow fractures. Traditionally, displaced fractures have been treated with open reduction although recent studies have demonstrated successful outcomes of closed reduction for similar injuries. This study investigates the outcomes comparing open and closed reduction in a large cohort of children with moderately displaced (Song classification types 1 to 4) lateral humeral condyle fractures.
Methods:
Retrospective data from patients aged between 1 and 12 years treated for lateral condyle fractures was collected from 6 academic level 1 trauma centers between 2005 and 2019. Data was collected on patient demographics, radiographic parameters, reduction type, type of hardware fixation, and fracture patterns. Complications recorded include infections, reoperations for nonunion, osteonecrosis, and elbow stiffness.
Results:
An initial 762 fractures were identified. After excluding Song 5 cases, a total of 480 fractures met inclusion criteria, with 202 (42%) treated with closed reduction and 278 (58%) treated with open reduction. Demographics and injury characteristics were similar across the 2 reduction cohorts. After propensity score matching, delayed healing (52% vs. 28%; OR: 2.88, 95% CI: 1.97-4.22; P <0.0001) and stiffness (22% vs. 10%; OR 2.42, 95% CI: 1.42-4.13; P =0.0012) were significantly higher in the open reduction group. No differences in the rates of infection or nonunion (3% CR and 1% OR) were noted between the 2 groups.
Conclusion:
This study demonstrates that moderately displaced lateral condyle fractures requiring open reduction are more likely to have elbow stiffness and delayed healing when compared with the ones treated with closed reduction. For these reasons, we propose attempting closed reduction techniques as the first line of treatment in moderately displaced lateral humeral condyle fractures (if anatomic articular reduction can be achieved) to attain better patient outcomes.
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