1. 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

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

3. 5 cases of Jakob stage 3
: entrapped fragment

4. CR & percutaneous pinning
Acceptable reduction confirmed by arthrogram

6. 1-20months postoperatively

8. 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

10. F/ 5 yrs 0 mos
Stage 2
POP 10 months

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

13. 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.

14. Jakob stage 3  2
Jakob stage 2  CR

15. 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

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

18. Thank you for your attention