Transverse Anterior Approach to the Elbow for Pediatric Displaced Lateral Humeral Condyle Fractures

The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a bettervisualization of the articular fracture resulting in better functional results, less complications and a more cosmeticallyappealingscar than usually seen with the lateral approach.

Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCFvia an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignmentand complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level ofsatisfaction with the cosmetic appearance of the scar.

Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classifiedas Jackob’s Type II in 14 cases and Milch’s type II in all cases. Mean follow-up was 12 (range 4 to19) months.Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operativecomplications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, activeelbow ROM of at least 90%, was obtained. All parents claimed to be “very satisfied” with their child’s scar. A lateral spurwas identified in 66.7% o patients.

The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilagereduction. Complications after this technique might decrease compared to the lateral approach but need futurecomparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage ofthis approach compared to the classical lateral approach.Level of evidence: IV