Lateral humeral condyle fractures in children: a comparison of two approaches to treatment.

The treatment of lateral condyle fractures in children remains controversial. This study investigates whether minimally displaced lateral condyle fractures should be treated surgically and compares different techniques of operative management. The authors retrospectively reviewed medical charts and radiographs of 97 children from two international centers whose therapeutic modalities differed, noting demographic data, fracture features, treatment modalities, complications, and clinical and radiographic results. Long-arm immobilization alone resulted in additional fracture displacement and a higher number of nonunions than did surgical management. The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex. If patients are likely to be noncompliant with treatment, the wires should be buried under the skin to avoid the risk of infection, but this procedure necessitates a second surgery for removal of fixation.