Variation in the treatment of pediatric lateral condyle fractures of the humerus: a survey of Pediatric Orthopedic Society of North America members

To determine surgeon preference and predictors for implant choice during operative treatment of pediatric lateral condyle fractures of the humerus (PLCFH). A cross-sectional survey was disseminated to the POSNA membership in January 2023. Respondents provided their current treatment preferences for PLCFHs, implant recommendations for 11 case vignettes, and willingness to randomize the implant in each case. Regression analysis was used to identify predictors of treatment recommendations. Of the 159 surgeon responses (11% of membership), 94% used K-wires (47% exclusively), 54% used screw fixation (6% exclusively), and 48% used both. Screw fixation was more commonly used by surgeons with more than 30 years of experience ( P = 0.048). There were zero cases with full consensus on the implant choice and five with less than 75% agreement. Screw fixation was more commonly recommended for fractures presenting more than 2 weeks after injury [odds ratio (OR) = 50.4, 95% confidence interval (CI): 14.1–179.5] and in older patients (per year, OR = 1.8, 95% CI: 1.4–2.2) after controlling for surgeon experience and fracture severity. Open treatment was recommended in 78% and randomization of implant type was recommended in 54% of case responses. While surgeons primarily favor K-wires, screw fixation was preferred for late-presenting PLCFHs and older patients. There was a lack of consensus on treatment recommendations within each case. The majority were willing to randomize the implant type. This survey therefore shows equipoise to justify the development of a prospective, randomized, multicenter study to design evidence-based guidelines for implant choice in PLCFH. Level of Evidence Level III – survey study.