Kirschner Wire Fixation of Neglected Lateral Condylar Fracture of the Humerus in Children

Background: Delayed presentation of lateral condylar fractures of the humerus is relatively common in the developing regions of the world. Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Materials and Methods: Twenty-one children having fracture of lateral condyle of humerus with duration of trauma more than 3 weeks were included in the prospective study. Among the 21 patients, 13 were male and 8 were female. Average time of presentation was after 3 weeks of injury. All patients had Milch type II injury. The patients were treated by open reduction and internal fixation using Kirschner wire. The outcome assessment according to the scoring system proposed by Dhillon et al. was used. Result: Mean month at operation is 81.5 months (range, 64 112 months); 8 Right/13 Left. Reason for presentation: Pain, swelling in 12; Pain, decreased elbow motion in 7; Restriction of the elbow flexion in 2. Time from injury to Operation with mean 6.34 weeks, 3 weeks ≤ 6 weeks in 13 Patients, and > 6 weeks in 8 patients; Previous treatment: Plaster cast in 15 Patients, and No treatment in 6 Patients; Mean time of Follow-up: 66 Months; Mean Age at last Follow-up was 11.6 (range, 8.4 15.0). To tell result, 38.1% is in Excellent; 33.3% is in Good; 14.3% is in Fair; and 14.3% is in Poor. Comparison of accepted result from time of injury to operation was 3 6 weeks better than over 6 weeks with P Valuate 0.001387. There were AVN in 1 case, Nonunion in 2 cases. Conclusion: Osteosynthesis by Kirschner wire without bone grafting could provide solid bony union and improve elbow function. However, this technique could not prevent an angular deformity completely. Corrective osteotomy should be considered in patients with valgus or varus deformities.