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Pediatric Lateral Condyle Fracture

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 5-year-old girl is brought to the emergency department after falling onto her outstretched hand. She has pain and swelling over the lateral aspect of her left elbow. She is reluctant to move the elbow. On examination, there is focal tenderness over the lateral condyle with soft tissue swelling. The elbow is held in flexion. She has full finger movement and normal sensation. Radial pulse is present.
AP and lateral radiographs of a 5-year-old's left elbow demonstrating a Milch Type II lateral condyle fracture. The fracture line extends through the lateral condyle into the trochlea (crossing the physeal plate). There is >2mm displacement with rotation of the fragment. The lateral crescent sign is visible. Internal oblique view would better delineate displacement. This fracture requires open reduction and internal fixation.
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AP and lateral radiographs of a 5-year-old's left elbow demonstrating a Milch Type II lateral condyle fracture. The fracture line extends through the lateral condyle into the trochlea (crossing the physeal plate). There is >2mm displacement with rotation of the fragment. The lateral crescent sign is visible. Internal oblique view would better delineate displacement. This fracture requires open reduction and internal fixation.

Source: Lateral Condyle Fractures of Humerus in Children • PMC3543890 • CC-BY

Questions

Question 1 (4 marks)

Describe the imaging findings and classification systems.

Question 2 (5 marks)

What is unique about lateral condyle fractures compared to other pediatric elbow fractures?

Question 3 (6 marks)

Describe the treatment algorithm and surgical technique.

Question 4 (5 marks)

What are the complications of lateral condyle fractures?

Question 5 (4 marks)

How do you manage a late-presenting or established malunion?

Question 6 (4 marks)

Explain the elbow ossification centers and relevance to imaging.

Exam Day Cheat Sheet

Must Mention

  • •Milch: Type I (lateral to trochlea) vs Type II (through trochlea)
  • •Jakob: I (undisplaced), II (moderate), III (complete)
  • •<2mm = cast, >2mm = ORIF
  • •High nonunion risk (synovial fluid)
  • •Posterior blood supply (avoid anterior dissection)
  • •Cubitus valgus, tardy ulnar nerve palsy

Common Pitfalls

  • •Confusing Milch I and II
  • •Not knowing nonunion risk
  • •Wrong surgical approach
  • •Missing displacement in cast
  • •Wrong CRITOE ages
  • •Missing late complications