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Lateral Condyle Fracture

  • Second most common fracture of the elbow
  • Varus force on extended, supinated elbow

Classification

Milch

Milch Classification of Lateral Condyle Fractures
Type Description
1
  • lateral throught the trochlear groove
  • splits the ossification center of the capitellum
  • SH IV
2
  • passes into the trochlear region between the ossification centers
  • like SH 2

Jacob

Jacob Classification of Lateral Condyle Fractures
Stage Description
1
  • articular surface is intact
2
  • into joint but no fracture fragment rotation
3
  • rotated & displaced
  • Stage 1 & 2 can be treated closed

Treatment

  • If the displacement is greater than 1 mm or more than 2 mm vertical then the articular portion is likely disrupted & unstable
  • If undisplaced (< 2mm)
    • treat with cast & frequent re-xray
    • if displaces later then 2 weeks there is a high incidence of  AVN with ORIF
    • care must be taken to avoid dissecting posteriorly
  • If displaced greater than 3 mm
    • open reduction bringing the extensor wad forward
    • do not stripping posteriorly to avoid AVN of the capitellum
    • use two pins one through the capitellum & the other in metaphysis

Complications

Late Nonunion

  • May see proximal migration, cubitus varus  & tardy ulnar nerve palsy
  • Preoperative get NCS & EMG
  • Fix the fragment in situ with minimal stripping
  • Transpose ulnar nerve
  • Subsequent supracondylar osteotomy

Lateral Epicondyle Fracture

  • Typically treated conservatively

 

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