O3252: Immobilization following Lateral Condyle Fractures: Early Motion is Safe

Background: Immobilization is required following operatively treated lateral condyle fractures to provide adjunct stability; however, there remains significant variability in surgeons’ postoperative protocol. Previous literature describes postoperative protocols ranging from three to six weeks of immobilization without a clear consensus. This study aims to compare an early motion protocol of four weeks or less of immobilization to a six week or longer immobilization period, evaluating the differences in postoperative range of motion, healing, and complications.

Methods: This was a retrospective, single center cohort study of acute, isolated, lateral condyle fractures in pediatric patients presenting from 2013-2024 treated operatively with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Patients were categorized into two groups: an early motion group, with four weeks or less of total immobilization, or a standard group, with six weeks or greater of total postoperative immobilization. We compared range of motion as described by Flynn at interval follow up, complications, including infection, malunion/nonunion, and unplanned return to OR, and radiographic union between groups. Univariate statistical analyses were performed with IBM SPSS Statistics v29.

Results: 174 elbows (174 patients, 60 [34%] female, mean age 6.5 ± 2.5 years) were included: 78 in the early motion group, and 96 in the standard motion group. There were no differences in age, sex, Song classification, or open versus closed reduction (Table 1). The early motion group had a significantly higher incidence of isolated screw fixation compared to the standard group (23% vs 3%, p< 0.001). The three patients (all males, mean age 9.6 years, mean BMI 19.3) with screw fixation in the standard group sustained Song 4 fractures and had nearly full recovery of motion (two with 0°-5°, one with 5°-10° loss of ROM) and experienced no complications. There was no significant difference in loss of elbow ROM (p=0.71) , complication rates (p=0.73), or radiographic union rates (p=1.00) between groups (Table 1). In the early motion group, two patients experienced malunion/nonunion that required return to OR. In the standard group, two patients underwent return to OR due to malunion/nonunion, and soft tissue infection at the site of implant occurred in one patient. Sub analysis of patients with loss of ROM ≥15° compared to all other patients found significantly lower rates of radiographic union and higher complication rates; there was no difference in duration of cast immobilization between groups.

Conclusion: For acute, isolated lateral condyle fractures, an early motion immobilization protocol allowing motion at four weeks or less yields noninferior outcomes compared to a longer protocol.