O1064: Less Common Than Expected: Late Displacement After Pediatric Lateral Condyle Fractures of the Elbow

Background: The incidence of late displacement among pediatric lateral condyle fractures has been described as 8.5-18%. However, these studies are limited by small cohort sizes. The aim of this study was (1) to determine the rate of late displacement and nonunion among lateral condyle fractures following immobilization in a large cohort and (2) to establish additional radiographic criteria to help surgeons choose between immobilization and operative fixation for minimally displaced fractures by following outcomes among the two treatment pathways.

Methods: We performed a dual center retrospective study of patients with lateral condyle fractures between 1999 and 2020. Patient demographics, injury mechanism, time to orthopedic presentation, duration of cast immobilization, and complications following casting were recorded.

Results: After application of inclusion and exclusion criteria, 239 patients with lateral condyle fractures were included for analysis. The initial management in 64% of patients (154/239) was nonoperative, of which two had delayed displacement at follow up and one developed delayed union requiring surgery (failure in 3/154, 1.95%). The mean displacement on AP view was 1.3 +/- 1.1 mm and lateral view was 0.50 +/- 1.0 mm for nonoperative treatment. For operative treatment, the mean displacement on AP was 6.6 +/- 5.4 mm and lateral view was 5.3 +/- 4.1 mm (Figure 1).

Conclusion: Our analysis found the rate of late displacement in patients treated with immobilization was lower than previously reported (1.3%; 2/154). Among patients treated nonoperatively, 91.4% had an AP displacement < 3.5 mm and lateral displacement < 3 mm. Utilizing these displacement measurements as a cut-off for nonoperative treatment in the otherwise appropriate patients (e.g. no vascular injury, nerve injury, etc.) may prevent unnecessary surgery in children with minimally displaced and stable fractures that are likely to heal with nonoperative management. Future prospective studies are necessary to form consensus guidelines on the management of pediatric lateral condyle fractures.