Paediatric Lateral Humeral Condyle Fractures in Wales: A National Multicentre Evaluation of Operative Management

Background Lateral humeral condyle (LHC) fractures are the second most common paediatric elbow injury. Treatment ranges from cast immobilisation to open reduction with internal fixation. We present the largest cohort of operatively managed LHC fractures in Wales and assess regional service provision. Objectives To evaluate trends in operative management of paediatric LHC fractures across Wales. Methods We retrospectively reviewed children undergoing operative management of LHC fractures from January 2024 to June 2025 across six hospitals in five health boards. Data on demographics, injury, operative details, and complications were collected from imaging, operation notes, and clinic letters. Statistical analyses included Kruskal–Wallis (inter-board time to operation), Spearman correlation (Weiss classification vs timing), and Mann–Whitney U (wire removal: clinic vs theatre). Results Thirty patients (mean age 7.2 years; 19 male) were included. Cases by health board: ABUHB 16, CAV 3, SBUHB 1, WMH 5, GC 2, GGH 3. Median time to operation was 3 days (range 1–58) with no inter-board difference (p = 0.972). Four initially missed fractures in ABUHB were managed at 7–15 days. Fixation was performed by consultants (n=15), specialty doctors (n=6), and registrars (n=9). Weiss classification negatively correlated with time to operation (ρ = –0.562, p = 0.02). Median wire removal was 54 days (range 21–159), occurring significantly earlier in clinic (p < 0.001). Conclusions Operative timing is consistent across Wales, with prioritisation of more severe injuries. Variation in wire removal, surgeon grade, and occasional missed fractures highlights opportunities to improve training and service delivery.