Closed vs. open reduction in lateral condylar fractures of the humerus in children

1. Case Presentation
• 6 y.o. boy K/C of coarctation of the aorta status post
repair
• referred to Dr. Hamdi with Hx of Fall down to Lt elbow
9/7 before time of presentation.
• Family went to private clinic @ time of injury  Dx soft
tissue injury, put him in back slab & discharged.
• Pt seen in cardiology clinic then referred to Dr. Hamdi.
• Seen in 1-2-2011 & Admitted.
• Pt was C/O pain & he was on back slap.
• Distal NV intact.

6. Closed vs. Open Reduction in
Lateral Condylar Fractures of
Humerus in Children
By
Dr. Yousef T. Khoja (R1)

8. Materials and Methods
• Prospective studied 63 pts, 2001 – 2005 with
lateral condylar #.
• 4 views : anteroposterior, lateral, internal
oblique, and external oblique x-ray
• Measured from the lateral metaphyseal cortex
of the distal part of the humerus to the lateral
cortex of the fracture fragment.
• Greatest displacement on any single
radiograph was recorded as the amount of
displacement of the fragment.

13. Result
• 63 pts:
– 42 boys : 21 girls.
– Mean age 6 4/12 yr old.
– Rt 35 : 28 Lt.
– Mean F/U 25/12.

14. Result
• 63 pts:
– Stage1 & 2: 43 stable #  excellent outcome.
– Stage 3: 17 pts
• 13 pts were reduced to ≤ 1mm
• Remaining 4  Rx w/ in situ pin fixation w/o
attempts reduction
– Stage 4: 40 ats.
• 30 pts were reduced to ≤ 2 mm
• Remaining 10  ORIF was performed
– Stage 5: 6 pts.
• 3 pts were reduced to ≤ 2 mm
• Remaining 3  ORIF was performed

18. Result
• Complication:
– 11 pts had osteophyte formation w/o any
symptoms.
– 4 pts had mild hypertrophy of the
capitellum with no change in angle.
– There were no serious complications such
as osteonecrosis of the trochlea or
capitellum, nonunion, malunion, or early
physeal arrest

19. Result
• According to the criteria of Hardacre et al:
– 96 %  excellent.
– 4 %  good.
– 0 %  poor.
• 46/63 ( 73 % ) were reduced and stabilized
with good results and no serious
complications.

20. Conclusion
• CRIF is an effective treatment for unstable
displaced lateral condylar fractures of the
humerus in many children. If fracture
displacement after closed reduction exceeds
2 mm, ORIF is recommended.