LAUSR

It is generally accepted that childhood fractures are more bening in nature, compared with fractures of mature skeleton, due to high rate of union and the great potential of remodeling [1]. Nevertheless, they are just lateral humerus condyle fractures if any that are usually associated with complications. Lateral condyle fractures result in less satisfactory outcomes than other elbow fractures in children [2]. In this regard, I warmly appreciate the purpose of the recent systematic review by Dr. Tan et al., while they aimed “to better describe the characteristics and complications” of these challenging fractures [3]. Tan et al. included 44 studies in their review and found significant morbidity: Varus deformity was found in 7.8%, valgus deformity in 6.1%, flexion loss 9.7% and extension loss in 11.5% of the patients. They deduce that fractures with displacement > 2 mm show increased risk of complications. Finally, they are frustrated for the low level of evidence in the current literature and warrants comparative studies on the outcomes. The report by Tan et al. is interesting but there is an important issue in clinical point of view that was not managed at all: long-term outcomes. It is previously stated that they should be rather long-term than short-term outcomes of pediatric fractures that matter [4]. Growing skeleton is a dynamic structure and the conclusions about the recovery should be made after satisfactory follow-up. There is one more recent prognostic level II study of pediatric lateral condyle humerus fractures beyond the review by Tan et al. [5]. In total, 32 patients and 32 ageand sex-adjusted reference cases were included and the results and complications were evaluated with mean 12.4 years of follow-up [6]. Surprisingly, the long-term findings were close to similar to the findings by Tan et al.: despite the long follow-up time until the end of bone growth, there were still 40% of the cases that did not reach satisfactory outcomes, as measured using the Flynn’s criteria for elbow assessment [7]. Altogether, 15.6% still demonstrated > 15° loss of flexion-extion movement. Carrying angle change was still a problem, while 25% had cubitus varus and 15.7% had cubitus valgus. This strengthens the understanding of poor coronal plane remodeling despite the long post-injury follow-up. As a conclusion, the noteworthy complications of lateral condyle humerus fractures Tan et al. reported in their fine review are further emphasized by understanding that they seem to be permanent in nature. Fortunately, as concluded by Sinikumpu et al., the major findings in many patients with previous lateral condyle fracture seem not to interfere much in their daily activities: long-term Mayo Elbow Performance Scorings were close to respective scorings in normal controls at 12 years.