Question
A 5 year old girl falls onto her outstretched hand and has lateral elbow swelling. Radiographs show a lateral condyle fracture displaced by 3 mm.
- How are these fractures classified?
- Why are they important to recognise?
- Outline your management.
Answer
Classification
- Milch classification type I through the ossific nucleus (lateral to the trochlear groove) and type II through the trochlear groove, which is more unstable
- Jakob stages, undisplaced with intact hinge, displaced but not rotated, and displaced and rotated
- Displacement measured on internal oblique views, which show it best
Importance
- Intra-articular Salter-Harris IV injury
- Pulled by the wrist extensors, so displacement is common
- High risk of nonunion, malunion and cubitus valgus with tardy ulnar nerve palsy
- Fishtail deformity and avascular necrosis can follow
Management
- Under 2 mm displacement, long arm cast with close radiographic review at 1 week
- 2 to 4 mm with intact articular cartilage, closed reduction and percutaneous pinning after arthrogram
- Over 4 mm or articular incongruity, open reduction through a lateral approach, avoiding posterior dissection to protect the blood supply
- Two divergent K wires or a screw for older children
- Late nonunion may need fixation with bone graft
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.