Immobilization Following Operative Treatment of Lateral Condyle Fractures: Early Motion Is Safe

Immobilization is required following operatively treated lateral condyle fractures to provide adjunct stability. However, there is no clear consensus regarding optimal duration of postoperative immobilization. This study aims to compare an early motion protocol of four weeks or less of immobilization to a six week or longer immobilization period, evaluating the differences in postoperative range of motion, healing, and complications. We performed a retrospective, single center cohort study of acute, isolated, lateral condyle fractures in pediatric patients presenting from 2013-2024 treated operatively with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Patients were categorized into an early motion (EM) group, with four weeks or less of total immobilization, or a standard (SM) group, with six weeks or greater of total postoperative immobilization. We compared range of motion at interval follow-up, complications, and radiographic union between groups. Univariate statistical analyses were performed with IBM SPSS Statistics v29. 174 elbows (174 patients, 60 [34%] female, mean age 6.5 ± 2.5 years) were included: 78 in the EM group, and 96 in the SM group. There were no differences in age, sex, Song classification, or open versus closed reduction. There was no significant difference in loss of elbow ROM (p=0.71), complication rates (p=0.73), or radiographic union rates (p=1.00) between groups. In the EM group, two patients experienced malunion/nonunion that required return to OR. In the SM group, two patients underwent return to OR due to malunion/nonunion, and soft tissue infection at the site of implant occurred in one patient. Subanalysis of patients with loss of ROM ≥15° compared to all other patients found significantly lower rates of radiographic union and higher complication rates; there was no difference in duration of cast immobilization between these groups. For acute, isolated lateral condyle fractures, an early motion immobilization protocol allowing motion at four weeks or less yields similar outcomes compared to a longer protocol. Level IV (Retrospective Cohort Study) Up to 5 key concepts in complete sentences • There is significant heterogeneity in postoperative immobilization protocol for isolated lateral condyle fractures in pediatric patients. • Early mobilization may allow faster return to activities without an increased risk of complications compared to longer immobilization protocols. • Patients who exhibit postoperative stiffness were significantly more likely to demonstrate radiographic nonunion (9% versus 1%, p=0.04) and have a postoperative complication (19% versus 2%, p=0.001) versus the remainder of the cohort.