{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:52:54Z","timestamp":1773391974274,"version":"3.50.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to evaluate the outcomes of a two-stage surgical protocol\u2014comprising open reduction and internal fixation (ORIF) with bone grafting followed by corrective osteotomy\u2014for managing cubitus valgus deformity secondary to neglected lateral condylar fracture non-union in older children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed nine patients (5 males, 4 females; mean age, 11.1 years; range, 10\u201314 years) who underwent this two-stage procedure between January 2015 and January 2023. The mean interval from initial injury to first surgery was 7.7 years (range, 6\u201310 years). All patients presented with cubitus valgus deformity, ulnar neuropathy, and lateral elbow instability. The first stage involved ORIF via a lateral approach, thorough debridement of the non-union site, and filling of the bone defect with commercially available allogeneic or synthetic bone substitutes, stabilized with 4.0-mm cannulated screws and Kirschner wires. The limb was immobilized in a long-arm cast for three weeks, followed by active mobilization. The second stage\u2014a medial closing-wedge supracondylar humeral osteotomy\u2014was performed six months later and fixed with a reconstruction locking plate. Osteotomy hardware was removed six months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At a mean follow-up of 24.2 months (range, 16\u201335 months), all fractures achieved radiographic union. The mean preoperative carrying angle of 37.4\u00b0 (range, 31\u00b0\u201345\u00b0) improved to a mean of 10.8\u00b0 (range, 9\u00b0\u201314\u00b0), which is within the normal range and closely matched the contralateral side. Elbow range of motion was restored to near pre-injury levels, with no joint laxity or avascular necrosis of the lateral condyle. All symptoms of ulnar neuropathy resolved completely. Outcomes were rated as satisfactory in all patients according to the Flynn criteria, with no treatment failures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this small retrospective series, the two-stage surgical strategy appears effective in addressing both mechanical instability from non-union and the functional\/cosmetic deficits of cubitus valgus in older children with neglected lateral condylar fractures. However, given the limited sample size and relatively short follow-up duration, these preliminary findings warrant validation through larger prospective studies with longer-term observation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1767262","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:48:13Z","timestamp":1773384493000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-stage surgical reconstruction for cubitus valgus secondary to neglected lateral condylar fracture non-union in older children"],"prefix":"10.3389","volume":"14","author":[{"given":"Yuan","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-wei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chi","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-qiang","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-han","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Sichuan Provincial Orthopedics Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"B1","volume-title":"Rockwood and Wilkins\u2019 Fractures in Children","author":"Flynn","year":"2014"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2673","DOI":"10.2106\/JBJS.G.01227","article-title":"Closed reduction and internal fixation of displaced unstable lateral condylar fractures of the humerus in children","volume":"90","author":"Song","year":"2008","journal-title":"J Bone Joint Surg Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"423","DOI":"10.4103\/ortho.IJOrtho_319_16","article-title":"Management of neglected lateral condyle fracture of humerus: a comparison between two modalities of fixation","volume":"52","author":"Ranjan","year":"2018","journal-title":"Indian J Orthop"},{"key":"B4","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/BPB.0000000000000443","article-title":"Open reduction versus in-situ fixation of neglected lateral condyle fractures: a comparative study","volume":"27","author":"Prakash","year":"2018","journal-title":"J Pediatr Orthop B"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.2106\/00004623-197153060-00003","article-title":"Fractures of the lateral condylar of humerus in children","volume":"53","author":"Hardacre","year":"1971","journal-title":"J Bone Joint Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1097\/01241398-198911000-00012","article-title":"Nonunion of slightly displaced fractures of the lateral humeral condylar in children: an update","volume":"9","author":"Flynn","year":"1989","journal-title":"J Pediatr Orthop"},{"key":"B7","doi-asserted-by":"publisher","first-page":"187","DOI":"10.2106\/00004623-197557080-00009","article-title":"Prevention and treatment of non-union of slightly displaced fracture of the lateral humeral condylar in children","volume":"57","author":"Flynn","year":"1975","journal-title":"J Bone Joint Surg Am"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.2106\/00004623-197153060-00004","article-title":"Non-union of minimally displaced fractures of the lateral condylar of humerus in children","volume":"53","author":"Flynn","year":"1971","journal-title":"J Bone Joint Surg Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1302\/0301-620X.57B4.430","article-title":"Observations concerning fractures of the lateral condylar of humerus in children","volume":"40","author":"Jakob","year":"1975","journal-title":"J Bone Joint Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1001\/jama.1958.02990030018005","article-title":"Fractures of the elbow in children; 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