LATERAL CONDYLE FRACTURE THROUGH THE CAPITELLUM IN A CHILD

THOM BROWN, M.D., Resident, Orthopaedic Surgery

WILLIAM MACKENZIE, M.D., Attending, Pediatric Orthopaedic Surgery

November 15, 1995

CLINICAL CASE PRESENTATION

ORTHOPAEDIC DEPARTMENT

THE ALFRED I. DUPONT INSTITUTE

WILMINGTON, DELAWARE

CASE HISTORY:
ETIOLOGY

17% of all pediatric elbow fractures.

More common in summer months 5-10 years of age (2-14)

Mechanism: varus stress to an extended elbow with supinated forearm

CLASSIFICATION

ANATOMIC: (Milch)

DISPLACEMENT: (Rutherford)

DISPLACEMENT RISK: (Finnbogason)

TREATMENT
COMPLICATIONS
CONCLUSIONS
  1. Fractures of the lateral condylar physis that exit through the capitellum should be treated with the same indications as a Milch II fracture with emphasis placed on achieving and maintaining articular congruity until healed by closed or more often open means.
  1. The length of time to maintain internal fixation and casting should be dictated by the radiographic appearance of the healing fracture more so than the length of time of immobilization. Displacement with has been reported between 3 and 4 weeks post fracture.
REFERENCES
  1. Dhillon, K.S., et al., Delayed Management of the Lateral Condyle in Children. Acta Orth. Scand. 1988; 59(4), 419-424.
  1. Finnbogason, T., et al., Nondisplaced and Minimally Displaced Fractures of the Lateral Humeral Condyle in Children: A Prospective Radiographic Investigation of Fracture Stability. JPO,1995; 15, 422-425.
  1. Flynn, J., Nonunion of Slightly Displaced Fracture of the Lateral Humeral Condyle in Children: An Update. JPO, 1989; 9,691-696.
  1. Flynn, J, and Richards J., Nonunion of Minimally Displaced Fractures of the Lateral Condyle of the Humerus in Children. JBJS, 1971, 53A No. 6, 1096-1 101.
  1. Jakob, R. et al., Observations Concerning Fractures of the Lateral Humeral Condyle in Children. JBJS 57B No. 4,430-436.
  1. Masada, K, et al., Osteosynthesis for Old Established Non-Union of the Lateral Condyle of the Humerus. JBJS, 1990, 72A, -)2-40.
  1. Marzo, J., et al., Usefulness and Accuracy of Arthrocraphy in Manacement of Lateral Humeral Condyle Fractures in Children. JPO, 1990, 10, 317-32 1.
  1. Milch, H., Fractures and Fracture-Dislocations of the Humeral Condyles. J. Trauma, 1964, 4, 592-607
  1. .Roye, D., et al., Late Sur-ical Treatment of Lateral Condylar Fractures in Children. JPO, 1991, 11, 195-199.
  1. Rutherford, A., Fractures of the Lateral Humeral Condyle in Children. JBJS, 1985, 67A No. 6, 851-856.
  1. Wilkins, K., Operative Management of Upper Extremity Fractures in Children. American Academy of Orthopaedic Surgeons Monograph Series. 1994, 66-70