Risk factors for ultrasound-guided closed reduction failure of unstable humeral lateral condylar fractures in children: a retrospective study

To identify risk factors for ultrasound-guided closed reduction with percutaneous pinning (CRPP) failure in unstable humeral lateral condylar fractures (HLCFs) in children. This retrospective study reviewed ultrasound-guided treatment of patients with unstable HLCFs admitted to one hospital from January 2022 to August 2023. The patients were divided into CRPP and CRPP failure groups. Sex, injury side, age, body mass index (BMI), Song classification, Milch classification, subcutaneous ecchymosis, sagittal deviation, interval between injury and surgery (IIS), nighttime surgery, surgery within the first 3 months of surgeon’s experience, and elbow dislocation were identified as risk factors for CRPP failure. Independent risk factors and incidence risk were analyzed. In total, 158 patients (aged 1–14 years; mean age 5.30 ± 2.35) were enrolled; 22 (13.9%) had CRPP failure. Univariate analysis revealed no significant difference in sex, injury side, BMI, Milch classification, Song classification, subcutaneous ecchymosis, nighttime surgery, and elbow dislocation between groups. The IIS, sagittal deviation, and surgery within the first 3 months of surgeon’s experience showed statistically significant differences between groups. Binary logistic regression analysis revealed that anterior displacement and surgery within the first 3 months of surgeon’s experience were independent risk factors for CRPP failure. Ultrasound-guided CRPP is prone to failure in patients with unstable HLCFs, an IIS > 5 days before surgery, anterior displacement, and surgery within the first 3 months of surgeon’s experience. These findings can help surgeons make better judgments and preoperative treatment plans for patients with HLCFs.