PAPER 2 MGR UNIVERSITY

1. Fracture of lateral humeral
condyle
Dr.Ponnilavan

2. Lateral humeral condyle
• Include
• Capitellum
• Lateral epicondyle

3. 2nd m/c pediatric elbow # after SCH#
• characterized by a higher risk of nonunion, malunion,
& AVN than other pediatric elbow #s.
• Malgaigne described lateral humeral condylar
fracture in 1847

4. Epidemiology
• represent 12% to 20% of pediatric elbow
fractures
• It typically occurs in children aged
approximately 6 - 10 years
• Fracture of necessity

5. • most commonly are Salter-Harris IV fracture
patterns of the lateral condyle
• Pathophysiology- M.O.I -
– pull-off theory
• avulsion LC # that results from pull of common extensor
musculature
– push-off theory proposed by Milch
• FOOSH causes radial head impaction into lateral
condyle causing #

6. • Associated with posteromedial elbow
dislocations
• Ossification-
• lateral (external) epicondyle ossifies at age 11
years
• fuses at age 12-14 years

7. CL. f
Lateral ecchymosis implies a tear in aponeurosis of
brachioradialis & signals an unstable fracture

8. CLASSIFICATIONS

9. Milch cl
• Type 1 -
• # line courses lat to trochlea &
exits into capitellotrochlear
groove resulting in a SH type IV
#
• Elbow remains stable bcz
trochlea is intact.

10. • Type II#- # line that extends into
apex of trochlea,
• Resulting in a SH type II #.
• Elbow - unstable bcz trochlea-
disrupted.

11. • Jakob et al -
based on
fracture
fragment
displacement

12. type I , fragment is nondisplaced + intact articular surface.
II- fracture is moderately displaced + extends to the articular surface.
III - fragment is completely displaced + often rotated.

13. • Other cl- Finnbogason et classification

14. Investigations
• Xray, CT Scan,MRI , USG , Arthrography
• Song et al - internal oblique view more
accurately demonstrates degree of
displacement than AP view

15. • Nonop -
• long arm cast x 4-6wks
– indi
• < 2 mm displacement in all views
• medial cartilaginous hinge must remain intact
• Op
• CRPP + 3-6 wks in A/E cast
– indi
• 2 - 4 mm of displacement + intact articular cartilage

16. • ORIF + 3-6 wks in A/E cast
• indi
– > 4mm displacement
– joint incongruity
– fracture non-union

17. • Typically, reduction of lateral condylar
fracture is achieved with an open procedure.
- Kocher approach to the lateral aspect of the
elbow is traditionally used.

18. • supracondylar osteotomy
• indi
– deformity correction in late-presenting cubitus
valgus - rarely needed

19. Complication
• Stiffness- most common
• Growth Disturbance
• Nonunion is more common with fracture of
the lateral condyle than with other fractures
about the elbow .

20. • Some authors have suggested that fracture is
intra-articular and is exposed to synovial fluid,
thereby limiting its capacity to heal.
• Other proposed causes of nonunion include
• pull of extensor mechanism which inserts on
lateral condyle, and
• poor metaphyseal circulation to distal
fragment

21. • Nonunion is m/c in pts treated nonsurgically.
• Cubitus VaRus deformity is m/c in nd &
minimally displaced #s.
• Cubitus VaLgus, lc than varus deformity, is
believed to be caused by lateral physeal arrest

22. • Cubitus VaLgus may be associated with tardy
ulnar nerve palsy
• Tardy ulnar nerve palsy involves slow,
progressive paralysis of the ulnar nerve.
• It is caused by stretching of the nerve, as is
seen with cubitus valgus. Management with
anterior ulnar nerve transposition has yielded
good results

23. • Fishtail deformity is characterized by deepening
of the trochlear groove->does NOT predispose
to arthritis
• AVN-posterior dissection can result in lateral
condyle osteonecrosis