A Comparison of Closed Reduction and Open Reduction in Children with Fracture of Lateral Humeral Condyle

Shin, Hyun Dae; Rhee, Kwang Jin; Kim, Kyung Cheon; Lee, Jung Bum; Lee, Choong Hui

Abstract

PURPOSE
The fracture of humeral lateral condyle in children was classified and the complications and results were analyzed according to the treatment modality and the types of fracture. MATERIALS AND METHODS: 92 patients who could be followed up one year or more, and were treated for a humeral lateral condyle fracture from May 1995 to May 2001 were studied. 66 cases were male, 26 cases were female, and 79 cases were under 9 years of age. The Milch stage I encountered in 12 cases, and II in 80 cases. Jacob stage I were encountered in 15 cases, stage II in 59 and stage III in 18 cases. Conservative treatment was performed in 9 cases and surgery was performed in 83 cases. A closed reduction and internal fixation with K-wire was performed in 18 cases, and an open reduction and internal fixation was performed in 65 cases. RESULTS: The change in the carrying angle was not clinically significant except for 7 cases, with a cubitus varus and cubitus valgus deformity. The change in the carrying angle showed an average -1.3 (from +7 to -18). The results according to the Hardacre criteria were `excellent' in 46 cases, `good' in 41 and `poor' in 5. Regarding the complications, bony spur formation was encountered in 8 cases, overgrowth of the lateral condyle and cubitus varus in 4, cubitus valgus in 3, avascular osteonecrosis in 3, premature epiphyseal fusion in 2, nonunion in 2, delayed union in 1, fish-tail deformity in 1, local infection in 5, range of motion limitation in 2 and transient radial nerve palsy in 1 case. CONCLUSION: Humeral lateral condylar fractures have a high rate of complications and clincally significant complication appeared mainly in stage II and III. This suggests that more a careful dissection of the soft tissue and anatomical reduction in Jakob stage III is required in cases of an open reduction.