Surgical versus conservative management of minimally displaced (≤ 2 mm) pediatric lateral humeral condyle fractures: systematic review and meta-analysis

TL;DR

The study compares surgical and conservative treatments for minimally displaced pediatric elbow fractures and finds that surgery may be safer to prevent displacement.

Contribution

This is the first systematic review and meta-analysis specifically evaluating conservative versus surgical management for minimally displaced pediatric lateral humeral condyle fractures.

Findings

Conservative treatment had a 18.4% risk of secondary displacement compared to 5.4% with surgery.

No significant differences in elbow function or malunion were found between treatment groups for healed fractures.

Minimally displaced fractures may still be mechanically unstable, requiring careful monitoring.

Abstract

Lateral humeral condyle fracture (HLCF) is a common pediatric elbow injury. For minimally displaced fractures (≤ 2 mm), the optimal management strategy remains controversial. This systematic review and meta-analysis aimed to evaluate the feasibility and safety of conservative treatment for this specific subtype.

A systematic search of multiple databases was conducted to compare conservative and surgical management of minimally displaced (≤ 2 mm) pediatric HLCF. The primary outcome was fracture healing, defined by the absence of secondary displacement during follow-up. Secondary outcomes included elbow joint function, periarticular hyperplasia, and malunion.

Twelve studies involving 1,022 children met inclusion criteria. Secondary displacement occurred in 18.4% of conservatively treated patients compared with 5.4% of surgically treated patients, indicating a higher risk of treatment failure with non‑operative management. Among fractures that ultimately healed, no significant differences were observed between conservative and surgical groups in elbow function, periarticular hyperplasia, or malunion.

Even minimally displaced (≤ 2 mm) pediatric HLCFs may demonstrate mechanical instability during follow‑up. Conservative treatment should therefore be undertaken with caution, and close radiographic monitoring is essential to detect early displacement. Treatment decisions should integrate displacement magnitude, fracture stability, imaging findings, follow‑up reliability, and family preference.

The online version contains supplementary material available at 10.1186/s12891-026-09555-w.

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