Comparison of open and closed reduction and percutaneous pinning for pediatric lateral humeral condyle fractures: A systematic review and meta-analysis

Background:Open reduction and percutaneous pinning (ORPP) is commonly regarded as the primary treatment option for serious displaced lateral condyle fractures of the humerus (LCFs) in children. However, some authors have suggested that closed reduction and percutaneous pinning (CRPP) may be an appropriate method for treating LCFs. This meta-analysis aims to compare the outcomes of these 2 fixation techniques.Methods:Our study conducted a search of the Pubmed, Embase, and Cochrane Library databases for published research up to October 1, 2022. Our analysis comprehensively compared the operation failure rate, elbow function, and complication rate between CRPP and ORPP. This study was registered with PROSPERO (CRD42022379655).Results:Our analysis included 6 non-randomized controlled trials and 532 patients. We used the Newcastle Ottawa Scale to assess the bias risk of these studies, with scores ranging from 6 to 9. The results indicate that both CRPP and ORPP yielded satisfactory elbow function outcomes (OR = 0.35, 95% CI = 0.07-1.88, P = .22). However, CRPP had a significant rate of operative failure (17.65%, OR = 21.77, 95% CI = 3.98-119.08, P = .0004) but a lower likelihood of unsightly scars (OR = 0.06, 95% CI = 0.01-0.31, P = .008). The failure rate of surgery is 0% in ORPP. There were no significant differences found in total infection (OR = 0.46, 95% CI = 0.21-1.01, P = .05), avascular necrosis (OR = 0.84, 95% CI = 0.09-7.79, P = .88), delayed union (OR = 1.49, 95% CI = 0.06-37.35, P = .81), or surgical time (MD = 4.46, 95% CI = -25.92 to 34.84, P = .77).Conclusions:In comparison to ORPP, CRPP may result in a higher rate of operative failure but has been found to significantly reduce the occurrence of unsightly scars. Both CRPP and ORPP showed similar levels of postoperative functional satisfaction, with no statistical difference in other complications. Our research suggests that qualified closed reduction is a viable option for doctors to treat LCF.Levels of evidence:IV.