Pediatric lateral condyle humerus fractures: a comparison of closed reduction with percutaneous pinning and open reduction with internal fixation for displacement over 2 mm

Background: Lateral condylar humerus fractures (LCHFs) with displacement over 2 mm are commonly treated with open reduction and internal fixation (ORIF). However, closed reduction and percutaneous pinning (CRPP) has been proposed as an alternative. Limited research compares these methods for such fractures. This study aimed to evaluate outcomes of CRPP versus ORIF. Methods: We retrospectively reviewed pediatric patients with LCHFs displaced >2 mm, treated with CRPP or ORIF at five military hospitals between June 2018 and October 2023. Fractures were classified using the Song and Milch systems. We assessed age, sex, fracture characteristics, surgery duration, postoperative care, and complications. Results: Of 273 patients, 82 had Milch type I and 191 had type II fractures; 78 were Song stage 3, 123 stage 4, and 72 stage 5. CRPP was used in 102 cases, ORIF in 171. Both groups were similar in age, sex, displacement, and immobilization time. CRPP had shorter surgeries and pin durations and did not need a second procedure for pin removal. Most fractures healed without major complications. Common issues included bone spurs, lateral prominences, and reduced carrying angle, but no functional deficits. Aesthetic scarring was more common in ORIF. Elbow function and range of motion were comparable. Conclusions: CRPP and ORIF both yield good outcomes for pediatric LCHFs with >2 mm displacement. CRPP offers advantages like shorter surgery, no scarring, and avoiding additional procedures.