The effect of different internal fixation materials on Jakob type III lateral humeral condyle fractures in pediatric patients

TL;DR

This study compares different internal fixation methods for severe pediatric elbow fractures and finds similar outcomes but varying costs and recovery times.

Contribution

The study provides a comparative analysis of fixation materials for Jakob type III fractures in children, focusing on clinical outcomes and economic factors.

Findings

Absorbable screws avoid the need for a second surgery, reducing implant removal time.

Metal screws had higher hospitalization and material costs compared to other methods.

All methods showed similar functional outcomes and complication rates.

Abstract

Humeral lateral condyle fractures are common pediatric elbow injuries, with Jakob type III representing the most severe form. While open reduction and internal fixation is the standard treatment, consensus is lacking on the optimal fixation method. Inadequate fixation can lead to serious complications. The efficacy of absorbable internal fixation materials remains debated. This study aimed to evaluate the outcomes of different internal fixation materials for treating these fractures in children.

A retrospective review was conducted on 51 children (39 male, 12 female; mean age 4.8 years) with Jakob type III fractures treated surgically between January 2020 and December 2023. Patients were divided into three groups based on fixation: Kirschner wires (Group A), metal hollow screws (Group B), and absorbable hollow screws (Group C). Statistical significance was set at P < 0.05.

The average hospitalization was 3.8 ± 0.2 days, median operation time was 60 min, and mean follow-up was 25.2 ± 12.1 months. No significant differences were found among groups regarding gender, age, postoperative plaster fixation time, final carrying angle, elbow varus deformity, lateral condyle protrusion, Mayo elbow score, or satisfaction. However, significant differences existed in hospital stay, operation time, time to implant removal, total hospitalization costs, and material costs. Group B had a significantly longer hospital stay (mean 4.9 days) compared to Groups A and C (3.5 and 3.4 days). Operative time was longest in Group A (mean 60 min vs. 45 and 47 min). Implant removal time was significantly longer in Group B (median 93 days vs. 34 days in Group A). Group B had the highest total hospitalization costs (mean $2623.0), while Group C had the highest material costs (mean $996.5). Group A had the lowest costs in both categories.

Different internal fixation materials achieved comparable therapeutic effects for pediatric Jakob type III lateral condylar fractures. Absorbable screws provided the advantage of eliminating the need for a second surgery for removal.

The online version contains supplementary material available at 10.1186/s13018-025-06547-9.