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[Comparison of effectiveness between two surgical methods for humeral lateral condyle fractures in children]
Hailong Ma1, Qingjie Wu1, Fang Liu1
1Department of Orthopedics, Anhui Provincial Children's Hospital, Anhui Medical University Children's Medical Center, Hefei Anhui, 230051, P. R. China.
Insights
Ultrasound-guided closed reduction for pediatric humeral lateral condyle fractures (HLCF) is as effective as open reduction. This method reduces operation time and fluoroscopy use, potentially lowering complication rates.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Medical Imaging
Background:
- Humeral lateral condyle fracture (HLCF) is a common elbow injury in children.
- Surgical intervention is often required for displaced fractures.
- Minimally invasive techniques are being explored to improve outcomes.
Purpose of the Study:
- To compare the efficacy of ultrasound-guided closed reduction with Kirschner wire fixation versus open reduction with Kirschner wire fixation for pediatric HLCF.
- To evaluate operative parameters, complication rates, and functional outcomes.
Main Methods:
- Retrospective analysis of 53 children with HLCF treated between May 2020 and April 2023.
- Comparison between 25 patients managed with ultrasound-guided closed reduction and 28 with open reduction, both with Kirschner wire fixation.
- Assessment of operation time, fluoroscopy frequency, healing time, complications, and Flynn elbow function scores.
Main Results:
- Ultrasound-guided closed reduction showed significantly reduced operation time and intraoperative fluoroscopy frequency.
- No significant difference in fracture healing time or overall infection rates between groups.
- Excellent/good elbow function rates were high in both groups (96.0% closed vs. 92.9% open), with no significant difference.
Conclusions:
- Ultrasound-guided closed reduction is a comparable and potentially advantageous technique for pediatric HLCF.
- This method offers benefits in reduced operative time and radiation exposure.
- Further research may explore its broader application in pediatric fracture management.
Objective:
To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children.
Methods:
A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up.
Results:
In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation.
Conclusion:
The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.
