Risk stratification in conservatively treated pediatric lateral humeral condyle fractures: the prognostic value of articular gap and initial displacement - a retrospective cohort study.

Abstract

The optimal management of minimally displaced pediatric lateral humeral condyle fractures remains controversial because some fractures may displace or heal late despite apparently stable initial radiographs. This study aimed to identify radiographic predictors of instability and delayed union in conservatively treated fractures. We retrospectively reviewed 58 children with lateral humeral condyle fractures treated nonoperatively between 2019 and 2024 using a standardized radiographic protocol including anteroposterior, lateral, and internal oblique views. Serial displacement, time to radiographic union, and complications were analyzed. Predictors of displacement progression and delayed union were evaluated using multivariable analyses. Radiographic union was achieved in 57 of 58 fractures (98.3%). Clinically relevant displacement progression (≥1 mm) occurred in six patients (10.3%). The presence of a radiographic articular gap strongly predicted displacement progression (odds ratio = 12.0, 95% confidence interval = 1.80-80.05, P = 0.019) and was associated with major complications (P < 0.001). Initial displacement greater than or equal to 2 mm was associated with longer time to union (29.7 ± 5.3 vs. 24.6 ± 4.2 days; P = 0.001) and independently predicted delayed union (+4.75 days, P = 0.008). All major complications occurred in fractures with initial displacement greater than or equal to 2 mm. Most minimally displaced lateral humeral condyle fractures treated conservatively achieve reliable union. However, fractures demonstrating an articular gap or displacement approaching 2 mm represent a higher-risk subgroup prone to displacement progression, delayed union, and complications. Incorporating these radiographic markers into initial assessment may help guide surveillance intensity and treatment decisions in pediatric patients. Level III - retrospective cohort study.