Upper Extremitiy Fractures – Lateral Condyle Fracture

After working this past week, I have a new found love/disdain for upper extremity fractures in kids – not sure how 5 kids coordinated their injuries to all arrive at the same time… but it gives me hope for our future generations.

oThe x-ray of the elbow often causes palpitations in us/me.  Looking at all of those radiolucent areas can be confusing.
o    Recall: CRITOE – the order of the APPEARANCE of the elbow’s ossification centers

Capitellum                                     (F – 1yo / M – 2yo)
Radial Head                             (F – 3yo / M – 4yo)
Internal (medial) Epicondyle      (F – 5yo / M – 6yo)
Trochlea                                    (F – 7yo / M – 8yo)
Olecranon                                    (F – 9yo/ M – 10yo)
External (lateral) Epicondyle     (F – 11yo M – 12yo)

o    Lateral Epicondyle Fractures are the 2nd most common elbow fracture (10-20%)
o    Mechanism = Fall on outstretched hand with arm abducted and elbow extended
o    When compared to Supracondylar Fxs, there is often more Lateral Ecchymosis
o    The fracture line may not appear until 7-10 days after injury (trust your exam… splint liberally).
o    It may be difficult to diagnose and will often appear as a Salter-Harris II fracture, but in fact, the majority will be Salter-Harris IV and are highly unstable.

o    Management: only truly non-displaced fractures can be managed non-operatively.
Non-displaced fractures – minimal lateral soft tissue swelling
Significant soft tissue swelling likely indicates unstable fracture.
Casted fractures that appeared non-displaced may become displaced so close follow-up is needed.
Most will require operative pinning.

o    Complications – Non-union with growth arrest, avascular necrosis, valgus/varus deformity, Ulnar nerve palsy (although not acutely – the risk of neurovascular compromise is much lower than supracondylar fractures).

Wheeless, CR. Frx of the lateral condyle in children in Wheeless’ Textbook of Orthopaedics. Online: http://www.wheelessonline.com/ortho/frx_of_the_lateral_condyle_in_children

Sarraff, LM. and Haines, CJ. Common Orthopedic Injuries in the Pediatric ED. Pediatric Emergency Medicine Reports. 2010; 15: 77-91.