Lateral Condyle Fractures: Kirschner Wire or Screw Fixation?

Lateral condyle fractures of the distal humerus are the second most common elbow fracture among children. These fractures present unique considerations because of their intra-articular nature and potential for growth disturbances. Management of lateral condyle fractures depends on the amount of fracture fragment displacement, joint congruency, and presence or lack thereof of rotational deformity. Patients with nondisplaced and minimally displaced fractures can be treated nonsurgically, whereas those with displaced fractures (>2 mm) warrant surgical intervention either by closed reduction and percutaneous fixation or by open reduction and internal fixation. There is controversy regarding the optimal method of fixation regarding Kirschner wires or cannulated screws. Cannulated screws have recently increased in popularity because of improved stability in combination with reduced rates of infection and elbow stiffness; however, most surgeons recommend secondary surgery for removal of the hardware. The more traditional Kirschner wire fixation still exhibits satisfactory outcomes and avoids the need for secondary surgery but comes with longer immobilization periods and an increased lateral bump following fixation. Therefore, both modalities of fixation remain viable options, with their own advantages and disadvantages, which surgeons should consider when selecting their preferred method of fixation.