Radiographic decision-making may yield excellent outcomes for lateral condyle fractures
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Use of radiographic fracture displacement to guide surgical and clinical decision-making may yield excellent functional outcomes and comparable complication rates among pediatric patients with lateral condyle fractures, according to results.
David L. Skaggs, MD, MMM, and colleagues treated 55 pediatric patients with lateral condyle fractures with either long arm casting, closed reduction and percutaneous pinning or open reduction and percutaneous pinning based on whether they had a type 1, type 2 or type 3 fracture, respectively. Researchers assessed functional outcomes using the pediatric outcomes data collection instrument at 6 and 12 weeks and at 1-year follow-up.
Results showed 31% of patients had a type 1 fracture treated with a long arm cast, 15% had a type 2 fracture treated with closed reduction and percutaneous pinning and 54% had a type 3 fracture treated with open reduction and percutaneous pinning. Researchers found delayed union in five patients and pin site infection in three patients postoperatively. Delayed union occurred among 6% of patients with type 1 fractures, in 13% of patients with type 2 fractures and in 10% of patients with type 3 fractures, according to results. Researchers noted 11% of patients with type 2 and type 3 fractures had delayed unions fixed with K-wires, with a second operation with screw fixation required among all patients. At 1-year follow-up, researchers found no significant differences across pediatric outcomes data collection instrument domains when the study population was compared to normative data.
“Using a simple classification system based only on fracture displacement seen on standard X-rays, orthopedic surgeons can recommend treatment that will lead to a normal functional outcome by 1 year following treatment,” Skaggs, chief of orthopedic surgery at Children’s Hospital Los Angeles, told Healio Orthopedics. – by Casey Tingle
Reference:
Nazareth A, et al. ePaper 527. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Skaggs reports he a board or committee member for the CHLA Foundation, Growing Spine Foundation and Growing Spine Study Group; a paid consultant for Grand Rounds, NuVasive, Orthobullets and Zimmer Biomet; has stock or stock options in Green Sun Medical, Orthobullets and Zipline Medical Inc.; is on the editorial or governing board for the Journal of Children’s Orthopaedics, Orthobullets, Orthopedics Today and Spine Deformity; receives other financial or material support from Medtronic and Zimmer Biomet; receives research support from NuVasive; receives publishing royalties, financial or material support from Wolters Kluwer Health; and receives IP royalties and is a paid presenter or speaker for Zimmer Biomet.
Perspective
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Theodore Blaine, MD
This is an important study that tests the validity of a treatment algorithm for pediatric lateral condyle fractures of the elbow. Using fracture displacement as a guide to treatment (type 1, less than 2 mm; type 2, 2 mm to 4 mm; and type 3, greater than 4 mm), the authors assessed functional outcomes using the pediatric outcomes data collection instrument. Using this algorithm, the investigators found that patients returned to “normal,” as measured by pediatric outcomes data collection instrument scores, in all treatment methods (cast, closed reduction and percutaneous pinning, and open reduction and percutaneous pinning) when applied using the algorithm. Delayed union rates were not statistically different among the fracture types and treatments, although it is possible that the difference could not be detected in this group of 55 patients. We also do not know how the results may have changed if the treatments were applied using different criteria.
Despite these questions, this study provides good support for the use of this treatment algorithm in a common and difficult to treat pediatric elbow fracture. Fracture displacement may be used as a guide for surgeons treating pediatric lateral condyle fractures of the elbow.
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Nazareth A, et al. ePaper 527. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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