Pediatric emergency medicine trisk 3462 3462
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Lateral condyle fractures are difficult to visualize radiographically and
are prone to poor functional outcome when missed.
Most lateral condyle fractures are displaced intra-articular fractures
(Salter–Harris type IV) and often require open reduction to anatomically
reduce the articular surface.
Lateral condyle fractures are the second most common operative elbow fracture
in children. These fractures are easily missed radiographically due to the fracture
fragment being primarily cartilage, especially in younger children. The
emergency clinician should have a high level of suspicion for this diagnosis in the
setting of a FOOSH followed by isolated lateral elbow pain and tenderness,
possibly accompanied by local swelling and ecchymosis. Fracture pain is
exacerbated with wrist flexion on examination. Frequently, the lateral ligament
and the common extensor tendon remain attached to the fracture fragment, which
can be partially or totally avulsed from the distal humerus ( Fig. 111.20 ). The
lateral epicondyle ossifies at approximately 13 years old and fuses with the
capitellum around age 16 years. Consequently lateral condyle fractures are
uncommon in the skeletally mature pediatric patient. Routine anteroposterior and
lateral plain radiographs usually provide adequate fracture definition for severely
displaced fractures; however, with less severe injuries and before the capitellum
is ossified, oblique views, stress views, CT scan, or an MRI study be needed.
Undertreated lateral condyle fractures have potential complications of
displacement, malunion, and nonunion which may result in deformity and nerve
palsy. Orthopedic surgery consultation is recommended for surgical management
of lateral condyle injuries with displacement of 2 mm or greater. Nondisplaced or
minimally displaced (<2-mm) fractures may be immobilized in the ED in a
posterior splint with the elbow flexed to 90 degrees and the forearm in pronation.
However, given the instability of this fracture, in addition to immobilization,
orthopedic follow-up within 3 to 4 days is essential.
Medial Epicondyle Fractures
CLINICAL PEARLS AND PITFALLS
