Anatomic reduction of old displaced lateral condylar fractures of the humerus in children via a posterior approach with olecranon osteotomy.

Background/Purpose: We questioned the principle of treatment of late lateral condylar fracture of a pediatric elbow. We report the results of treating this condition using a different approach. Methods: We treated six children with type 3 late lateral condylar fractures. The average age was 4.5 years old. The time delay from injury to surgery averaged at 3.8 months. All the displaced lateral condyles were Milch type 2 with significant rotation away from the trochlea. The articular anatomic reduction of the lateral condyles was achieved via ulnar osteotomy in all six cases. We fixed both the fracture and the osteotomy with Kirschner wires buried under the skin. No strenuous passive physical therapy was needed. Results: All lateral condylar fractures and ulnar osteotomies were united within 3 months. Five out of six children had regained full range of motion and symmetric carrying angles at the latest follow-up 2 to 11 years later. Complications included transient physeal change and lateral bump. Conclusion: Based on our results, we recommend olecranon osteotomy via a posterior approach as one of the options in treating late cases of type 3 lateral condylar fracture of the elbow with significant displacement in children.