A novel single-portal arthroscopic technique for the management of pediatric humeral lateral condylar fractures

TL;DR

A new arthroscopic technique using a single portal is introduced for treating displaced elbow fractures in children, showing effectiveness and safety.

Contribution

A simplified single-portal arthroscopic technique for pediatric lateral humeral condylar fractures is proposed and validated.

Findings

All 18 pediatric patients successfully underwent the single-portal arthroscopic procedure.

The technique achieved excellent or good outcomes in 17 of 18 cases with minimal complications.

Operative time averaged 56.9 minutes with no major complications like nonunion or neurovascular injury.

Abstract

Surgical intervention is indicated for significantly displaced lateral humeral condyle fractures (LHCFs) in children. Arthroscopic-assisted closed reduction represents a minimally invasive alternative; however, its widespread adoption has been limited by the technical challenges inherent in both pediatric fracture management and elbow arthroscopy. This study introduces a simplified technique utilizing a single proximal anterolateral portal for arthroscopic-assisted reduction, which has shown promising efficacy and safety.

A retrospective analysis was performed on 18 pediatric patients with LHCFs who underwent arthroscopic-assisted closed reduction via a single proximal anterolateral portal at our institution between March 2024 and February 2025. The cohort included 14 boys and 4 girls, with a mean age of 6.1 ± 1.6 years. The mean interval from injury to surgery was 4.7 ± 2.1 days. Data on fracture classification, operative time, duration of K-wire fixation, and functional outcomes were collected and analyzed.

All 18 patients successfully underwent the procedure. The mean operative time was 56.9 ± 10.0 min, and K-wires were maintained for a mean of 35 ± 8.5 days. At the final follow-up, no significant differences in the carrying angle were observed between the injured and contralateral limbs. According to the Flynn criteria, 16 cases were rated as excellent and 2 as good. One case of a superficial pin site infection resolved with conservative wound care. No instances of delayed union, nonunion, neurovascular injury, or compartment syndrome were recorded.

The single proximal anterolateral portal technique for arthroscopic-assisted reduction of LHCFs facilitates minimally invasive debridement of the fracture site and provides direct visualization of the reduction process. This approach serves as a viable and effective alternative for managing lateral condylar fractures that are not amenable to conventional closed reduction due to severe displacement or a prolonged delay from injury. The technique demonstrates a favorable safety profile, and shows promise for broader clinical adoption pending further validation.

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