Lateral Humeral Condyle Fractures in Infants, Toddlers, Preschoolers, and School-Age Children: A Comparative Analysis and the Role of the N-Les-H Index.

Abstract

This study aims to comparatively evaluate clinical and radiologic outcomes of lateral humeral condyle fractures (LHCFs) in infants (0 to 12 mo), toddlers (1 to 3 y), preschool childrens (3 to 5 y), and school-age childrens (5 to 12 y) with a secondary objective of assessing the prognostic utility of the Normalized Lateral Elbow Swelling-to-Humerus Diameter (N-LES-H) index, particularly for Jakob Type I fractures. A total of 133 pediatric patients treated for LHCFs between 2012 and 2023 were retrospectively reviewed. Patients were stratified by age and treatment modality (operative vs. nonoperative). Fractures were classified per the Jakob system. For Jakob Type I injuries, the N-LES-H index was calculated using AP radiographs. Functional outcomes were measured through the Mayo Elbow Performance Score (MEPS) and Flynn criteria. Radiographic outcomes included deformity (varus/valgus), lateral condylar overgrowth, and avascular necrosis (AVN). Statistical analyses included logistic regression and ROC analysis. Among 133 patients (mean follow-up: 6.2 ± 2.5 y), 63 were <36 months (32 conservatively, 31 operatively treated) and 70 were >36 months (34 conservative, 36 operative). An N-LES-H index >1.8 significantly predicted surgical necessity in Jakob Type I fractures (AUC: 0.884, P<0.001). Varus deformity (>5 degrees) and condylar overgrowth were more prevalent in younger surgical patients (P<0.05). MEPS outcomes were excellent in 132 cases. According to Flynn criteria, outcomes were excellent in 114, satisfactory in 16, and poor in 3, with significant group differences (P<0.05). Although complication rates were higher in the <36-month cohort, age-appropriate treatment yielded favorable functional outcomes. Conservative management was effective in selected Type I and II fractures in this group, likely due to greater remodeling potential. The N-LES-H index proved to be a reliable, objective and age-independent tool for treatment stratification in Jakob Type I LHCFs. These findings support the integration of the N-LES-H index into clinical decision-making algorithms and warrant validation through future multicenter prospective studies. Level III-Retrospective comparative study.