Transverse Anterior Approach to the Elbow for Pediatric Displaced Lateral Humeral Condyle Fractures

Document Type : RESEARCH PAPER


1 Pediatric Hand Surgery and Microsurgery, UCA Unit, Vithas San Jose, Barcelona, Spain

2 ICATMA Hand and Microsurgery Unit; ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain

3 Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile


Background: The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a better
visualization of the articular fracture resulting in better functional results, less complications and a more cosmeticallyappealing
scar than usually seen with the lateral approach.
Methods: Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCF
via an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignment
and complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level of
satisfaction with the cosmetic appearance of the scar.
Results: Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classified
as Jackob’s Type II in 14 cases and Milch’s type II in all cases. Mean follow-up was 12 (range 4 to19) months.
Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operative
complications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, active
elbow ROM of at least 90%, was obtained. All parents claimed to be “very satisfied” with their child’s scar. A lateral spur
was identified in 66.7% o patients.
Conclusion: The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilage
reduction. Complications after this technique might decrease compared to the lateral approach but need future
comparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage of
this approach compared to the classical lateral approach.
Level of evidence: IV


Main Subjects

1. Beaty JH. Fractures of the lateral humeral condyle are
the second most frequent elbow fracture in children.
J Orthop Trauma. 2010; 24(7):438.
2. Silva M, Cooper SD. Closed reduction and
percutaneous pinning of displaced pediatric lateral
condyle fractures of the humerus: a cohort study. J
Pediatr Orthop. 2015; 35(7):661-5.
3. Mintzer CM, Waters PM, Brown DJ, Kasser JR.
Percutaneous pinning in the treatment of displaced
lateral condyle fractures. J Pediatr Orthop. 1994;
4. Song KS, Shin YW, Oh CW, Bae KC, Cho CH. Closed
reduction and internal fixation of completely
displaced and rotated lateral condyle fractures of
the humerus in children. J Orthop Trauma. 2010;
5. Jakob R, Fowles JV, Rang M, Kassab MT. Observations
concerning fractures of the lateral humeral condyle
in children. J Bone Joint Surg Br. 1975; 57(4):430-6.
6. Milch H. Fractures and fracture dislocations of the
humeral condyles. J Trauma. 1964; 4(1):592-607.
7. Imatani J, Morito Y, Hashizume H, Inoue H. Internal
fixation for coronal shear fracture of the distal end
of the humerus by the anterolateral approach. J
Shoulder Elbow Surg. 2001; 10(6):554-6.
8. Hausman MR, Qureshi S, Goldstein R, Langford J, Klug
RA, Radomisli TE, et al. Arthroscopically-assisted
treatment of pediatric lateral humeral condyle
fractures. J Pediatr Orthop. 2007; 27(7):739-42.
9. Song KS, Waters PM. Lateral condylar humerus
fractures: which ones should we fix? J Pediatr
Orthop. 2012; 32(Suppl 1):S5-9.
10. Bauer AS, Bae DS, Brustowicz KA, Waters PM.
Intra-articular corrective osteotomy of humeral
lateral condyle malunions in children: early clinical
and radiographic results. J Pediatr Orthop. 2013;
11. Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM,
Skaggs DL. A new classification system predictive
of complications in surgically treated pediatric
humeral lateral condyle fractures. J Pediatr Orthop.
2009; 29(6):602-5.
12. Haraldsson S. On osteochondrosis deformans
juvenilis capituli humeri including investigation of
intra-osseous vasculature in distal humerus. Acta
Orthop Scand. 1959; 30(sup38):5-232.
13. Pribaz JR, Bernthal NM, Wong TC, Silva M. Lateral
spurring (overgrowth) after pediatric lateral condyle
fractures. J Pediatr Orthop. 2012; 32(5):456-60.
14. Ersan O, Gonen E, İ􀇚lhan RD, Boysan E, Ates Y.
Comparison of anterior and lateral approaches
in the treatment of extension-type supracondylar
humerus fractures in children. J Pediatr Orthop B.
2012; 21(2):121-6.
15. Thomas DP, Howard AW, Cole WG, Hedden DM
Three weeks of Kirschner wire fixation for displaced
lateral condylar fractures of the humerus in children.
J Pediatr Orthop. 2001; 21(5):565-9.