Lateral Condyle fracturesDon't be deceived by small visible bony fragment, most of fragment is cartilage. This is a significant injury and prone to problems if not actively managed or closely watched! Asses displacement and soft tissue integrity to guide treatment. 12% of childrens elbow fractures. Classification
RadiologyAP Lateral Elbow - dont be deceived by small fragment, take note of displcement on lat. Arthrogram/ MRI - can be useful to asses grade of injury and demonstrate if any joint surface displacement ManagementUndisplaced fracture (less than 2 mm) - Conservative splint 2-3/52 then mobilise (Keep close eye! at 3- 5days remove splint and re x-ray, repeat 3-5 days later.) About 40% of lateral condylar physeal fractures are sufficiently undisplaced that they can be treated by simple immobilization. If fracture line is barely perceptible on the original x-ray, the degree of displacement usually is minimal and the chance for subsequent displacement is low. Only fractures with type I displacement (ie, the fracture line is seen on only one x-ray view) can be safely treated nonoperatively. Any undisplaced fracture, even if it is less than 2 mm, can displace later (8% stage I displace late). The potential to displace depends more on degree of soft-tissue injury and whether the articular cartilage of the trochlea is intact, rather than on the amount of initial displacement. Soft tissue swelling on the lateral aspect of the distal humerus, can be appreciated both clinically and on x-rays. If crepitus between the fragments is detected with motion of the forearm or elbow, significant loss of soft-tissue attachments and a potentially unstable fracture should be suspected.
Displaced - EUA and percutaneous K wires or ORIF (ensure joint congruity) Fractures with stage II displacement (2 to 4 mm), varus stress views should be obtained and arthrography performed. If the fracture is stable, percutaneous pinning is possible ORIF - If the fractures is grossly unstable (stage III displacement). avoid damage to blood supply of distal fragment. Pins out 3 weeks if there is adequate healing on x-rays. Pin removal can be delayed 1 to 2 weeks in older children. ComplicationsLate or neglected cases, treat the symptoms not the x ray or the clinical deformity.
See animation Last updated 11/09/15 |