Marcheix PS, Vacquerie V, Longis B et-al. Lateral epicondyle avulsion fracture: avulsion of the ossification center, not a transverse fracture through the condyle Supracondylar fracture: a transverse fracture usually through the supracondylar fossa The following complications may occur as a result of either non-operative or operative management 2,14:Ĭubitus valgus (>10%) with tardy ulnar nerve palsy, cubitus varus (>20%) When open reduction is performed it is important to avoid posterior and distal dissection as this may interrupt blood supply and lead to avascular necrosis 2. Operative management in displaced fractures takes the form of either closed reduction and percutaneous pinning or open reduction and internal fixation with a cannulated screw and washer 2,14. Non-operative management is indicated when the fracture is displaced 2 mm displacement on the internal oblique view, the risk of further displacement is high and operative management is recommended. The majority of these fractures are not displaced >2 mm (33-69%) 2 and can be treated conservatively. When describing a lateral condyle fracture, it is important to make comment about:ĭisplacement (in mm) on the internal oblique view However, whilst MRI does not change initial management it may be useful in the pre-operative planning in non-union 2. MRI will delineate the whole fracture (cartilage and bone) and may help to determine any additional injury. All the required information is usually present on the plain film. CTĬT may be helpful when making an assessment of a complex fracture, but is usually not required in a lateral condyle fracture. The Weiss classification uses the degree of displacement of the fracture and is a more relevant measure of severity. The Milch and Weiss classifications have been used for these fractures. This is because the fracture usually lies posterolaterally 14. The displacement of the distal fracture component is best demonstrated on the internal oblique view. 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 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. The fracture through the lateral condyle will have a large cartilaginous component as well as a small osseous portion. 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. Pull-off theory: the lateral condyle avulses due to the extensor carpi radialis longus and brevis creating a varus stress on a supinated forearm 2,4,5 Push-off theory: there is a direct force upwards and outwards causing the radial head to impact the capitellum 2 Two theories exist regarding the mechanism of injury: push-off and pull-off theories 2. These occur either after a fall onto an outstretched hand. They occur in school-age children, with a peak at 6 years 4. 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 are a completely different entity to a lateral epicondyle avulsion fracture where the ossification center is avulsed. Lateral humeral condyle fractures are usually simply termed lateral condyle fractures.
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