Open reduction and internal fixation for the treatment of fractures of the lateral humeral condyle with an early delayed presentation in children: a radiological and clinical prospective study.

Abstract

The treatment of late presenting fractures of the lateral humeral condyle in children remains controversial. We report on the outcome for 16 children who presented with a fracture of the lateral humeral epicondyle at a mean of 7.4 weeks (3 to 15.6) after injury and were treated surgically. The mean follow-up was four years (1.1 to 8.9), at which time the mean age of the patients was 8.7 years (3.2 to 17.8). The mean Dhillon functional score improved from 3.3 to 5.6 and the mean overall scores improved from 5.6 to 8.5. A total of seven patients had a fishtail deformity and eight had partial lateral epiphyseal closure. None had avascular necrosis. MRI showed an abnormal cartilage signal, incongruence of the joint surface and partial premature closure of the lateral physis in four patients. Neither age at the time of injury, the time interval between injury and operation, nor the pre-operative function were correlated with the incidence of complications. These results support the use of internal fixation for children with a lateral humeral epicondylar fracture with a delayed presentation. Open reduction and internal fixation yielded a satisfactory outcome within 16 weeks in children with a lateral humeral epicondylar fracture with a delayed presentation.