Reassessing hand dominance in pediatric lateral condyle fractures: A cohort study of surgical predictors

Lateral condyle fractures are the second most common elbow fracture in pediatric patients with high rates of articular involvement and displacement leading to surgical management. This study aims to assess whether dominant side fracture predicts conservative treatment change, undergoing surgical management or clinical outcomes in pediatric lateral condyle fractures and to identify independent predictors of surgery, loss of reduction, and complications.

Pediatric patients with lateral condyle fractures treated between 2019-2021 with documented hand dominance at injury were included. Outcomes included surgical management, change of conservative treatment, loss of reduction, and complications. Demographic and fracture characteristics were analyzed using descriptive statistics. Continuous variables were compared using Welch's t-test, and categorical variables using chi-square or Fisher's exact tests. Multivariate logistic regression identified independent predictors.

A total of 200 patients were included (mean age 5.98 ± 2.52 years; 65% male; mean BMI 18.58 ± 4.00 kg/m²; mean follow-up 88.9 ± 153.4 days). Mechanisms of injury included fall (50%), direct hit (35%), and FOOSH (15%). Weiss type 1 fractures predominated (61.5%), and fracture displacement occurred in 47.5%. Dominant-hand fracture was not an independent predictor of initial surgery, overall surgery, change to surgery, complications, loss of reduction, or subsequent surgery (all p > 0.05). Fracture displacement predicted initial surgery (OR = 8.91, p = 0.001), overall surgery (OR = 5.59, p = 0.002), and subsequent surgery (OR = 11.91, p = 0.035). Higher Weiss classification predicted initial and overall surgery (both p < 0.001). Non-FOOSH mechanisms increased loss of reduction (OR = 3.95, p = 0.039), and BMI > 85th percentile increased treatment change (p = 0.016).

Dominant side fracture was not an independent predictor of conservative management change, undergoing surgical management or clinical outcomes in pediatric lateral condyle fractures. Fracture displacement and higher Weiss classification were the strongest predictors of surgical intervention, while non-FOOSH mechanisms and elevated BMI were associated with higher risks of loss of reduction and change of conservative management, respectively.

Level III.