Lateral Condyle of Humerus Fracture 812.42

synonyms: lateral condyle fracture, pediatric lateral condyle fracture,

Lateral Condyle Fracture ICD-9

• 812.42(closed), 812.52(open)

Lateral Condyle Fracture Etiology / Epidemiology / Natural History

• 10%-20% of all pediatric elbow fractures (Mirsky EC, J Orhtop Trauma 1997;11:117-120)
• lateral approach 5-6cm incision ; interval between brachioradialis and triceps (Badelon O, JPO 8;31:1988)
• tardy ulnar nerve palsies occur usually occur 20 yrs after lateral condyle fracture

Lateral Condyle Fracture Anatomy

• fall on outstretched arm with varus moment leads to avulsion of lateral condyle by the common extensor origin

Lateral Condyle Fracture Clinical Evaluation

• Fall onto outstretched hand or direct blow.
• Pain and swelling in the lateral elbow.
• Document NV exam before and after any treatment.

Lateral Condyle Fracture Xray / Diagnositc Tests

• A/P. lateral and oblique xrays
• Consider arthrography to assess intra-particular extention of fracture and adequacy of reduction. (Marzo JM, JPO 1990;10:317-321)

Lateral Condyle Fracture Classification / Treatment (Jakob R, JBJS Br 1975;57:430-436)

• Type 1 = nondisplaced; <2mm of fracture displacement.  Generally stable if fracture does not extend into joint. RX=long arm posterior mold for 5days.  XOP at 5 days.  If Fracture remains unchanged LAC.  F/U with XOP’s at 14 days.  Continue with every 14-21 day XOP’s/LAC until fracture union.  May require 8-12 weeks to achieve union.  If >12wks, consider surgical fixation.
• Type 2=lateral displacement greater than 2mm, and the joint surface is usually disrupted.  Rx=CRPP (Mintzer CM, JPO 1994;14:462-465) If conpression is needed across Fracture site consider pushing on fragment with the chuck end of a 4.5mm drill placed over the iniial K-wire.  Also consider compression screw.  Confirm reduction with arthrogram.
• Type 3 = significant displacement including radiocapitellar joint displacement.  Rx=see Type 2.
• Open reduction via Kocher approach (tticeps-brachioradialis).  Avoid dissection posterior to lateral condyle to preserve blood supply to capitellum. 

Lateral Condyle Fracture Associated Injuries / Differential Diagnosis

• Elbow Dislocation
• Supraconylar Humerus fracture
• Medial Epiconyle fracture

Lateral Condyle Fracture Complications

• nonunion, capitellar osteonecrosis, fishtail  deformity of the distal humerus, premature growth arrest of capitellar physis, progressive lateral overgowth and cubitus varus, lateral prominence of the distal humerus
• excessive valgus of the elbow may lead to ulnar nerve palsy
• nonunion may lead to elbow instability, pain, and apprehension.  Elbow ROM is typically well maintained.

Lateral Condyle Fracture Follow-up Care

• LAC for 4-6 weeks.  K-wires are removed when there radiograhpic signs of union(3-6wks). 

Lateral Condyle Fracture Review References

• Rutherford A, JBJS 1985:67A:851
• Lovell and Winter's Pediatric Orthopaedics 2012
• °