What must we respect in articular fractures in childhood?

Articular fractures in children are rare and occur mainly in the elbow and ankle joint. Condylar fractures of the humerus, olecranon fractures, medial malleolar, and transitional fractures of the distal tibia are the commonest, though there is an increasing incidence of avulsion fractures of the intercondylar tibial eminence. Conservative treatment is recommended in articular displacements of less than 2 mm, but dislocation of more than 2 mm is a commonly accepted indication for surgery. Although this widely accepted guideline is based on clinical results, it is not scientifically proven. In addition, it is unknown whether there is any difference in the outcome for articular fractures if there is a step or gap, if the joint is weight-bearing or not, or the joint is immobilized or mobilized post-operatively. In experiments with rats, rabbits, and sheep, some clues have suggested that exact reconstruction of the chondral surface, fixation with compression of the fragments, and early continuous passive motion are advantageous. A prospective clinical study with a pre- and postoperative MRI scan is needed, in weight-bearing and non-weight bearing joints to show the factors influencing the outcome of these injuries.