Outcomes of ORIF >7 Days After Injury in Displaced Pediatric Lateral Condyle Fractures.

BACKGROUND: The purpose of the present study was to evaluate the effects of surgical timing on the outcome of pediatric lateral condyle fractures (LCF). We hypothesize that performing open reduction and internal fixation (ORIF) for a displaced LCF between 7 and 14 days after the occurrence of injury does not result in significant changes in outcome, as compared with those treated within the first 7 days.

METHODS: A total of 181 pediatric LCFs treated with ORIF, with a mean follow-up of 38 weeks and a mean age of 5 years, were included. All information related to the patient's elbow injury was prospectively collected. We identified 2 specific groups: 133 LCFs that were treated within the first 7 days after injury (group 1), and 48 that were treated between 7 and 14 days after injury (group 2). A satisfactory outcome was one in which there was evidence of healing of the fracture, a range of motion of at least 85% of the normal, contralateral side at the latest follow-up, and no evidence of complications, loss of fixation, infection, or avascular necrosis of the lateral condyle.

RESULTS: Overall, the mean time from injury to surgery was 5 days (range, 0 to 14 d). Initial fracture displacement was slightly larger in group 1 versus group 2, by a mean of 2.6 mm (P=0.004). There were no iatrogenic nerve injuries or vascular complications in either group. There was no difference in the mean surgical time between groups (P=0.004). At the latest follow-up appointment, elbows in both groups had similar range of motion (P=0.5), a low and similar rate of complications, and comparable rates of satisfactory outcomes (88.0% vs. 87.5%; P=0.6).

CONCLUSION: Our study suggests that performing an ORIF for a displaced pediatric LCF up to 14 days after the original injury does not adversely affect the outcome of the procedure.

LEVEL OF EVIDENCE: Level II-comparative study.