Anterolateral approach for lateral humeral condylar fractures in children Clinical results

To evaluate the clinical outcomes of an anterolateral approach for lateral humeral condylar fractures in children. The patients aged < 15 years undergoing surgery with an anterolateral approach for humeral lateral condylar fractures between April 2005 and March 2014 were investigated. Medical records and radiographs from 15 patients were reviewed. Average patient age at surgery was 6.0 years (range, 3-10 years). Based on Jakob's classification, 12 patients had type II fractures, and 3 patients had type III fractures. Based on Milch classification, 1 elbow was type I, and 14 elbows were type II. The average postoperative follow-up duration was 16.4 months (range, 6-58 months). Postoperative complications, and radiographic and clinical findings, including range of motion and Flynn criteria were evaluated. To evaluate humeral deformity, Baumann angle (BA) and the carrying angle (CA) were calculated on anteroposterior radiographs. There were no postoperative complications, including secondary displacement, deep infection, nonunion, avascular necrosis, or cubitus varus or valgus deformity. In the injured elbow, follow-up radiographs revealed an average BA of 69.1 degrees (range, 57-84 degrees), versus 70.9 degrees (range, 61-83 degrees) on the contralateral side. The average CA on the injured side was 10.3 degrees (range, 4-20 degrees) versus 12.3 degrees (range, 6-24 degrees) on the contralateral side. BA gain and CA loss (affected-compared with contralateral sides) averaged similar to 1.4 degrees (range, similar to 17 degrees to 9 degrees) and 2.3 degrees (range, similar to 2 degrees to 6 degrees), respectively. The mean range of motion in the affected elbow averaged 4.7 degrees (range, 0-15 degrees) in extension and 139.7 degrees (range, 135-140 degrees) in flexion. Over 5 degrees loss of range of motion in the affected elbow compared with the contralateral side was not observed. However, 2 patients experienced over 5 degrees loss of CA in the affected elbow versus the contralateral side. Based on Flynn criteria, clinical results for both cosmetics and function were excellent in 13 patients, and good in 2. The advantages of the anterolateral approach are combining an optimal view of the anterior articular surface of the trochlea and capitellum and a limited risk of devascularization injury. We strongly recommend an anterolateral approach for these fractures in children to prevent postoperative deformity and to achieve anatomical reduction and reliable fixation.