• 
• 

Three Part Question

in [a child aged 3-12] with [a fractured lateral condyle of the humerus] is [surgical intervention associated with a better oucome than immobilisation]

Clinical Scenario

an eight year old child presents to the emergency department with signs of a fracture. Radiology shows a fracture of the lateral condyle of the humerus.

Search Strategy

Medline 1966-June 2005
CINAHL 1982-June 2005
the cocrane library, issue 2, 2005

Search Outcome

56 citations of which 1 high quality retrospective clinical trial was found

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Launay Aug 2004 France	97 children under the age of 12	retrospective clinical trial	best mode of treatment	surgery leads to better outcome than immobilisation	retrospective in nature, therefore treatment protocols varied according to physican preference at two different institutions. Patients not randomly selected and nor was treatment given. Some patients discontinued follow up.
			best method of surgery	3 K-wires associated with better outcome than the use of 2 K-wires
			mobility after treatment	decreased loss of flexion with surgery. But decreased loss of extension with immobilisation

Comment(s)

the treatment of a lateral condle of the humerus fracture is associated with complications and loss of function. surgical management has been shown to lead to less complications after treatment and with decreased loss of flexion after treatment. immobilisation is associated with decreased loss of extension after treatment.

Clinical Bottom Line

surgical management is asasociated with better outcome than immobilsation

References

1. Launay Lateral condyle fractures in children: a comparison of two approaches to treatment