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

Background: The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a better visualization of the articular fracture resulting in better functional results, less complications and a more cosmeticallyappealing scar than usually seen with the lateral approach. Methods: Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCF via an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignment and complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level of satisfaction with the cosmetic appearance of the scar. Results: Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classified as 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-operative complications occurred. In all cases bone unio‎n was obtained 4 to 5 weeks after surgery and at final follow-up, active elbow ROM of at least 90%, was obtained. All parents claimed to be “very satisfied” with their child’s scar. A lateral spur was identified in 66.7% o patients. Conclusion: The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilage reduction. Complications after this technique might decrease compared to the lateral approach but need future comparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage of this approach compared to the classical lateral approach.