Inje University Sanggye Paik Hospital Yong Woon Shin Closed reduction and percutaneous pinning for severely displaced lateral condylar fracture in children Inje University Sanggye Paik Hospital Yong Woon Shin

Lateral condylar fracture 2nd most common fracture on elbow Intraarticular, physeal injury  OR & pinning : Tx of choice for displaced fracture

5 cases of Jakob stage 3 : entrapped fragment

CR & percutaneous pinning Acceptable reduction confirmed by arthrogram

1-20months postoperatively

CR & percutaneous pinning Cons CR - risk of LOM, late arthritis Pros OR - risk of nonunion, avacular necrosis, infection, large scar CR - arthrogram to confirm reduction Case Controversy, J Orthop Trauma 17(4), 2003

F/ 5 yrs 0 mos Stage 2 POP 10 months

Displacement pattern of stage 3 fracture : external rotation in axial plane and coronal plane

Fragment is entrapped between bone and brachioradialis m Fragment is entrapped between bone and brachioradialis m. This is a kind of button hole, which is torn open laterally. Elbow flexion releases the tension of muscle and makes the button hole wide. : Push the fragment on its anterior surface posterolaterally in flexing the elbow. Pronation makes rotated fragment in neutral position.

Jakob stage 3  2 Jakob stage 2  CR

Prerequisites for CR & Percutaneous pinning Within 72hrs since the trauma Clear cut fracture margin on C-arm : not Milch type 1, comminuted fracture, nor trochlear ossification center Unacceptable reduction on C-arm, converted to OR : gap > 1mm on lateral or internal oblique view : visible crack on arthrogram Internal oblique view demonstrated the degree of displacement more accurately than did the AP view. Song KS et al. JBJS 2007

Conclusion Closed reduction and percutaneous pinning could be used even in severely displaced lateral condylar fracture, but it should be done upon strict criteria.

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