Outcomes for Completely Displaced and Rotated Lateral Humeral Condyle Fractures in Children: A Multicenter Study

INTRODUCTION: Song V lateral humeral condyle fractures represent a displaced and rotated fragment, historically treated with open reduction and percutaneous pinning (ORPP) or screw fixation (ORSF). We aim to describe outcomes of Song V fractures and analyze the effect of fixation and reduction type on outcomes. METHODS: This retrospective review assessed data from 6 level 1 trauma centers from 2005 to 2019. Inclusion criteria were children aged 1 to 12 with a Song V fracture. Patient clinic and surgical notes until 1 year after the primary intervention were reviewed. Radiographic healing data were collected. Complication metrics included nonunion, delayed union, elbow stiffness, and superficial or deep infection. RESULTS: A total of 281 Song V lateral humeral condyle fractures were analyzed from the 6 centers. The mean age was 8.8 years, and 65.1% were male. K-wires were used in 223 patients (79%) and screws in 58 patients (21%). In all, 6 patients (2.1%) experienced a superficial infection, and 6 patients (2.1%) experienced a deep infection. Five patients experienced nonunion (1.8%). For patients undergoing an ORSF, 78% were radiographically healed at 3 months compared to 81% of patients undergoing an ORPP. No statistically significant differences between ORSF and ORPP were observed for outcome measures such as nonunion, stiffness, and infection, but notably, all 12 infections occurred in the K-wire group. Open reduction was utilized in 268 (95.4%) patients, compared with closed reduction in 13 (4.6%) patients. No significant relationships were seen between reduction type and complications, although results suggested increased rates of infection and elbow stiffness for those with open reduction. CONCLUSIONS: The current study is the largest analysis of Song V fractures. We found nonunion and deep infection to occur in roughly 2% of patients. Outcomes were comparable between ORSF and ORPP, with similar rates of radiographic healing, nonunion, and stiffness, while increased infection rates were seen for ORPP. Our findings also suggest closed reduction may be noninferior to open reduction, although further research with a larger sample size is necessary. LEVEL OF EVIDENCE: Level III.