Lateral Condyle Fractures - Pediatric

• 15% of pediatric elbow fractures
• Second only to supracondylar
• Peak age 5-7 years
• Slight male predominance
• Usually fall onto outstretched hand

• Lateral condyle (capitellum + part of lateral trochlea)
• Extends through articular surface
• Physis involved (Salter-Harris pattern)
• Lateral collateral ligament attaches to fragment

• Fall mechanism (FOOSH with varus stress)
• Time since injury
• Any swelling or deformity
• Neurovascular symptoms
• Previous elbow injury

• Lateral elbow swelling and tenderness
• Ecchymosis (may be extensive)
• Full neurovascular exam
• Check elbow stability (compare to opposite)
• ROM likely limited by pain

A lateral bony prominence (spur) and mild lateral condylar overgrowth is extremely common after healing of a lateral condyle fracture — even well-reduced ones — and is almost always benign and cosmetic. The key clinical task is to reassure the family that it is NOT a nonunion: it represents periosteal/healing new bone, the fracture is united, and it usually remodels and becomes less prominent with growth. Surgery is rarely needed for the spur alone.

A late "fishtail" (V-shaped) notch of the central distal humerus between the capitellum and trochlea, caused by osteonecrosis or growth arrest of the lateral trochlea following lateral condyle (or supracondylar/T-condylar) fractures, and aggravated by posterior soft-tissue stripping at surgery. Often an incidental radiographic finding years later, but it can cause pain, clicking, restricted motion or progressive deformity. Recognising it explains why preservation of the posterior blood supply is critical during ORIF.

• 15-20% of paediatric elbow fractures; second only to supracondylar
• Peak age 5-7 years; slight male predominance
• Mechanism: fall on outstretched hand with varus (pull-off) or push-off load
• Roughly 40-60% are displaced enough to warrant surgery across published series

• National arthroplasty registries (NJR, AJRR, AOANJRR, SHAR) do not capture paediatric trauma
• Evidence base is observational cohorts and society position statements, not registry survival data
• No randomized trial defines the exact displacement threshold

• Routine internal oblique views, fluoroscopy and intraoperative arthrogram
• Increasing use of closed reduction and percutaneous pinning
• MRI/CT available for occult or complex fractures
• Day-case surgery with structured pin-site care and early clinic review

• Higher proportion of late presentation, nonunion and cubitus valgus
• Reliance on plain radiographs and comparison views; arthrogram less available
• Open reduction more common where image intensifiers are scarce
• Reconstruction (osteosynthesis +/- osteotomy +/- ulnar transposition) forms a larger share of workload

Traditional teaching mandated open reduction for displacement over 2-4mm to confirm articular congruity. Song's prospective series and later cohorts show closed reduction with percutaneous pinning can succeed even in fully displaced/rotated fractures, with intraoperative arthrogram to confirm joint reduction. The trade-off is the inability to directly inspect the articular surface.

The operative threshold is debated. Many use over 2mm on the maximally displaced view; others reserve open surgery for at least 4mm (articular disruption), treating 2-4mm fractures with closed pinning after arthrogram. Weiss data link the 4mm point to articular incongruity and higher complications.

Smooth K-wires remain standard to spare the open physis, but cannulated/headless screws are increasingly used near maturity for compression and earlier motion. Comparative data show no clear outcome superiority of one implant over another.

Leaving pins percutaneous (exposed) allows clinic removal but carries pin-site infection risk; buried pins reduce infection but need a second anaesthetic for removal. Practice varies; pin-site infection is usually superficial and resolves with oral antibiotics and pin removal.