Clinical and radiological outcomes of open reduction and internal fixation for Kilfoyle type III pediatric medial humeral condyle fractures: a retrospective single-center study

Medial humeral condyle fractures are uncommon intra-articular injuries in children and are often overlooked because of delayed trochlear ossification. Delayed diagnosis or inadequate treatment may cause nonunion, malunion, growth disturbance, elbow deformity, and functional limitation. This retrospective single-center study evaluated clinical and radiological outcomes of pediatric medial humeral condyle fractures treated with open reduction and internal fixation (ORIF) at a tertiary referral center. Children aged 18 months to 12 years who underwent surgery between March 2016 and February 2022 with at least 2 years of follow-up were included. Fractures were classified using the Kilfoyle classification on radiographs, with computed tomography when the configuration was uncertain. Demographics, injury patterns, surgical details, complications, radiographic union, and elbow range of motion were reviewed from medical records. Seventeen children met the criteria. Mean age was 6.2 years (range: 1.5–12), and all fractures were displaced (Kilfoyle type III). The mean interval from injury to surgery was 1.9 days. Union was achieved in 16 of 17 patients (94.1%). Six patients (35.3%) developed complications: one nonunion requiring revision fixation, one malunion requiring corrective osteotomy, two cases of cubitus varus, and two cases of persistent extension deficit despite physiotherapy. No infection, neurovascular injury, or ulnar nerve palsy occurred. Fifteen patients achieved full flexion, and 13 regained full extension. ORIF provides satisfactory clinical and radiological outcomes for displaced pediatric medial humeral condyle fractures, with a high union rate and acceptable functional recovery. However, complications may occur, particularly in older children. Early diagnosis, accurate anatomical reduction, and long-term follow-up remain essential.