Efficacy and challenges of CRPP for Jakob type III lateral humeral condylar fractures: an age-stratified retrospective cohort study of 128 patients

Objective: Jakob Type III lateral humeral condylar fractures are common inarticulate fractures in pediatric population, and inadequate management may result in severe complications. This study aimed to evaluate the age-specific efficacy of closed reduction and percutaneous pinning (CRPP) in pediatric patients. Methods: A retrospective analysis was performed on 128 pediatric patients with Jakob III type lateral humeral condylar fractures who underwent CRPP at our institution from 2018 to 2024. Patients were stratified into three age groups: toddler group, preschool group, and school-age group. Intraoperative conversion to open reduction occurred in 11 cases in the toddler group and 1 case in the preschool group. All patients were followed up for at least 12 months. Outcome measures included surgical duration, intraoperative fluoroscopy time, 1-year MEPS, intraoperative conversion rate, primary reduction success rate, carrying angle, complication rate, and reoperation rate. Results: < 0.05). Postoperative carrying angle did not differ among groups. Within toddlers, no differences were found between CRPP and open reduction patients in MEPS, complications, reoperations, or angle changes. Conclusion: CRPP achieves favorable outcomes for pediatric patients with Jakob III lateral humeral condylar fractures across all age groups. However, the toddler group (0-3 years) exhibits unique therapeutic challenges: immature ossification complicates intraoperative fluoroscopic assessment, necessitating more frequent intraoperative strategy adjustments. Although the toddler group experiences higher CRPP difficulty and failure rates, timely conversion to open reduction and internal fixation (ORIF) as a salvage procedure yields comparable short-term functional outcomes to successful CRPP cases. These findings support age-based individualized surgical planning and flexible intraoperative adjustment strategies.