Lateral humeral condyle fracture
Citation, DOI and article data
Lateral humeral condyle fractures also referred to simply as lateral condyle fractures (in the appropriate context), are relatively common elbow fractures that predominantly occur in children. They may be subtle but are hugely important to diagnose in a timely manner because if they are missed, they have a tendency to migrate dorsally and without treatment can have significant morbidity.
Lateral humeral condyle fractures are usually simply termed lateral condyle fractures. They are a completely different entity to a lateral epicondyle avulsion fracture where the ossification center is avulsed.
They represent ~12.5% (range 5-20%) of elbow fractures in children and are the second most common pediatric elbow fracture after supracondylar fractures.
They occur in school-age children, with a peak at 6 years 4.
These occur either after fall onto an outstretched hand.
Two theories exist regarding mechanism of injury: push-off and pull-off theories2.
The push-off theory suggests there is a direct force upwards and outwards causing the radial head to impact the capitellum2.
The fracture can be underestimated on plain films and may be seen as a small sliver of bone adjacent to the proximal border of the capitellum. The fracture through the lateral condyle will have a large cartilaginous component as well as the small osseous portion.
The best view to see the lateral condyle fracture is an internal oblique and this should always be performed when a lateral condyle fracture has been diagnosed. This is done by pronating the arm, however, it is important to be aware that by placing the arm in pronation the fracture may be further displaced 14.
The displacement of the distal fracture component is best demonstrated on the internal oblique view. This is because the fracture usually lies posterolaterally 14.
CT may be helpful when making an assessment of a complex fracture, but is usually not helpful in lateral condyle fracture - you should be able to get all the required information from the plain film.
MRI will delineate the whole fracture (cartilage and bone) and may help to determine any additional injury. However, whilst MRI does not change initial management it may be useful in the pre-operative planning in non-union2.
When describing a lateral condyle fracture, it is important to make comment about:
- size of the osseous component
- displacement (in mm) on the internal oblique
- associated elbow joint effusion
- any additional injury
Treatment and prognosis
The majority of these fractures are not displaced more than 2 mm (33-69%)2 and can be treated conservatively. Non-operative management is indicated when the fracture is less than 2 mm displaced and when the medial cartilaginous hinge is intact. It involves long-arm casting for approximately 4-6 weeks 2, 14.
If there is more than 2 mm displacement on the internal oblique view, the risk of further displacement is high and operative management is recommended. Operative management in displaced fractures takes the form of either closed reduction and percutaneous pinning pr open reduction and internal fixation with a cannulated screw and washer2,14. When open reduction is performed it is important to avoid posterior and distal dissection as this may interupt blood supply and lead to avascular necrosis2.
The following complications may occur as a result of either non-operative or operative management2,14:
- delayed union
- fracture displacement
- cubitus valgus (>10%) with tardy ulnar nerve palsy, cubitus varus (>20%)
- avascular necrosis (osteonecrosis)
- fishtale deformity
- lateral overgrowth
- growth arrest (uncommon)
- 1. Marcheix PS, Vacquerie V, Longis B et-al. Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option?. Orthop Traumatol Surg Res. 2011;97 (3): 304-7. doi:10.1016/j.otsr.2010.10.007 - Pubmed citation
- 2. Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg. 2011;19 (6): 350-8. Pubmed citation
- 3. Marcheix PS, Vacquerie V, Longis B et-al. Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option?. Orthop Traumatol Surg Res. 2011;97 (3): 304-7. doi:10.1016/j.otsr.2010.10.007 - Pubmed citation
- 4. Contemporary Surgical Management of Fractures and Complications. Jaypee Brothers Medical Pub. ISBN:9350259648. Read it at Google Books - Find it at Amazon
- 5. Pope TL. Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. (2012) ISBN:145110720X. Read it at Google Books - Find it at Amazon
- 6. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. The Journal of bone and joint surgery. British volume. 57 (4): 430-6. Pubmed
- 7. Sullivan JA. Fractures of the lateral condyle of the humerus. The Journal of the American Academy of Orthopaedic Surgeons. 14 (1): 58-62. Pubmed
- 8. Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta orthopaedica Scandinavica. 57 (4): 309-12. Pubmed
- 9. Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta orthopaedica Scandinavica. Supplementum. 202: 1-109. Pubmed
- 10. Maylahn DJ, Fahey JJ. Fractures of the elbow in children; review of three hundred consecutive cases. Journal of the American Medical Association. 166 (3): 220-8. Pubmed
- 11. Blount WP, Schulz I, Cassidy RH. Fractures of the elbow in children. Journal of the American Medical Association. 146 (8): 699-704. Pubmed
- 12. Hanlon CR, Estes WL. Fractures in childhood, a statistical analysis. American journal of surgery. 87 (3): 312-23. Pubmed
- 13. Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J. Pediatric elbow fractures: a new angle on an old topic. Pediatric radiology. 46 (1): 61-6. doi:10.1007/s00247-015-3439-0 - Pubmed
- 14. 14) Knutsen A, Avoian T, Borkowski SL, Ebramzadeh E, Zionts LE, Sangiorgio SN. Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures. J Child Orthop. 2014 Feb;8(1):83-9. doi: 10.1007/s11832-014-0553-8. Epub 2014 Feb 2. PMID: 24488177; PMCID: PMC3935020