Pediatric lateral condyle distal humeral fractures are the 2nd most common elbow fractures that involve the growth plate. They account for 10% to 15% of all pediatric elbow fractures with a high incidence between 4 and 10 years of age [1,2]. These injuries are typically the result of an avulsion of a portion of the humeral condyle by pull of the extensor musculature due to a varus force on a supinated forearm or by the direct force of the radial head onto the condyle in the setting of a fall and axial load through an extended elbow [3]. The child with a lateral condyle fracture will usually present with lateral elbow pain and a limited range of elbow motion [4]. Unlike supracondylar fractures, lateral condyle fractures may not be associated with an obvious swelling or deformity. A high index of clinical suspicion and appropriate radiographic investigations are required to recognize the more subtle fracture patterns [5]. Undisplaced fractures may not be easily detectable on standard anteroposterior and lateral radiographs. Therefore, the addition of oblique views has been advocated [6]. Multiple treatment options are available for these fractures, ranging from simple immobilization for nondisplaced or minimally displaced fracture patterns, to operative reduction and fixation with Kirschner wires (K-wires) or screws for displaced fracture [7]. Although some controversy exists with regard to the acceptable amount of displacement. Fractures with displacement greater than 2 or 3 mm are generally thought to require reduction and fixation to facilitate union and prevent deformity and articular incongruity [8]. Because of concerns about the possibility of loss of fixation with brief use of K-wires or occurrence of infection with their prolonged use, Loke et al. explored the use of screw fixation for lateral condyle fractures [8]. The fractures have a high risk for complications including nonunion, malunion, ulnar nerve paresis, hypertrophic scar, avascular necrosis of ossific nucleus, and angular deformity [9]. |
