Orthopedic Research and Reviews (Mar 2020)
Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review
Abstract
Nicholas Birkett,1 Karam Al-Tawil,1 Alexander Montgomery2 1Princess Alexandra Hospital, Harlow, Essex CM20 1QX, UK; 2Royal London Hospital, London E1 1FR, UKCorrespondence: Nicholas BirkettPrincess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UKTel +44 79 6188 0429Email [email protected]: Lateral humeral condyle fractures are the second most common elbow fractures in children. Both K-wire fixation and screw fixation have been advocated as suitable treatment options for displaced fractures. This study aimed to identify which fixation method was associated with the best functional outcomes.Methods: A systematic review was conducted. Studies reporting functional outcomes following surgical fixation of lateral condyle fractures were included for review. The primary outcome measure was functional outcome. The secondary outcome measure was major complications. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies.Results: Ten retrospective non-randomised, comparative studies were eligible and included. No randomised-controlled trials were identified. The highest rate of excellent functional outcomes was seen with screw fixation (120/126 [95%]), compared with K-wire fixation (135/162 [86%]). The incidence of major complications was comparable, with complications in 6/95 (6%) of screw fixations and 6/141 (4%) K-wire fixations. A small sample of data on closed reduction demonstrated excellent functional results in 73 of 76 (96%) of patients. Closed reduction of displaced fractures is associated with a significant learning curve however.Conclusion: The evidence was of poor quality and comprised of retrospective case series. This prevented meta-analysis and any firm conclusions being drawn from the available data. Screw fixation may be associated with improved functional outcomes. Complication rates between the two methods are comparable. Further prospective studies are recommended.Keywords: lateral condyle fracture, paediatric, functional outcome, systematic review, K-wire fixation, screw fixation
