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Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children

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Abstract

Purpose

The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF).

Methods

This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12 months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients.

Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria.

Results

Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7 months (range, 12.3–40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5 min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40 s, respectively; p < 0.001).

Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09).

Conclusions

CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.

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Data availability

The data will be available upon reasonable request.

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Author notes

  1. Yanhan Liu and Weizhe Shi contributed equally to this work

Authors and Affiliations

  1. Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, 510623, China

    Yanhan Liu, Weizhe Shi, Yiqiang Li, Jingchun Li, Fuxin Xun & Hongwen Xu

  2. Department of Pediatric Orthopedics, Chenzhou No.1 People’s Hospital, Chenzhou, 423000, China

    Hai Zhao

  3. Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Av. Eugene Avinée, 59000, Lille, France

    Federico Canavese

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  1. Yanhan Liu
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Contributions

Yanhan Liu: study design; acquisition of data, analysis of data, interpretation of data, drafting of the work, final approval of the version to be published.

Weizhe Shi: acquisition of data, final approval of the version to be published.

Hai Zhao: acquisition of data, final approval of the version to be published.

Yiqiang Li: acquisition of data, statistical analysis, final approval of the version to be published.

Jingchun Li: acquisition of data, final approval of the version to be published.

Fuxin Xun: acquisition of data, stastistical analysis, final approval of the version to be published.

Federico Canavese: study design; analysis of data, interpretation of data, drafting of the work, final approval of the version to be published.

Hongwen Xu: interpretation of data, final approval of the version to be published.

All the authors contributed towards the literature search, critical review, data analysis, and manuscript preparation.

Corresponding author

Correspondence to Hongwen Xu.

Ethics declarations

Ethics approval

The Medical Ethics Committee of Guangzhou Women and Children’s Medical Center approved this retrospective review of prospectively enrolled patients. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from the parents.

Consent for publication

All authors listed have approved this manuscript. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Liu, Y., Shi, W., Zhao, H. et al. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. International Orthopaedics (SICOT) 46, 2291–2297 (2022). https://doi.org/10.1007/s00264-022-05476-0

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