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Lateral humeral condyle fracture - Milch type 2

Case contributed by Leonardo Lustosa
Diagnosis certain

Presentation

Fall onto the outstretched hand while running. Swollen right elbow.

Patient Data

Age: 3 years
Gender: Female

Radiographs revealed a lateral humeral condyle fracture, seen as a thin undisplaced sliver on the frontal view proximal to the capitellum ossification center.

Discrete elbow joint effusion noticed by the sail sign.

Case Discussion

Lateral humeral condyle fractures are the second most common elbow fractures in children. They usually result from a fall onto the outstretched hand with the elbow in full extension or a sharp blow to the palm with the elbow in flexion.

Milch type 2 fractures are unstable and go through the trochlear groove to apex. They can be also classified as a Salter-Harris type II physeal fracture.

In the present case, there was discrete elbow joint effusion, noticeable by the sail sign.

Finally, it's important to be familiar with the elbow ossification centers when assessing a pediatric elbow. In this case, only the capitellum, radial head, and medial epicondyle ossification centers are visible, which is normal given the patient's age.

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