A 6-year-old male presents to the ED after a fall from his 5 foot high bunk bed causing elbow trauma. On exam, there is significant focal swelling, ecchymosis, and tenderness at the lateral left elbow. The forearm, wrist, hand and shoulder are nontender. He is neurovascularly intact. You suspect a fracture and obtain x-rays (Figures 1 and 2).
Figure 1: Initial radiographs in the ED with the elbow slightly flexed.
Figure 2: AP and lateral radiographs of the elbow.
This patient has a laterally and volarly displaced lateral condyle fracture of the distal humerus with >2mm displacement (Figures 3 and 4).
Pearl: Radiographically, the lateral condyle fracture is often seen as a small metaphyseal crescent shaped fragment (sliver of avulsed metaphysis). The epiphyseal component may not be seen if it is not yet ossified. The distal fragment is often displaced or rotated, with alteration of the radiocapitellar alignment.
Figure 3: Initial radiographs in the ED with the elbow slightly flexed. Note the laterally and volarly displaced lateral condyle fracture of the distal humerus (green arrows).
Figure 4: AP and lateral radiographs of the elbow. Note the laterally and volarly displaced lateral condyle fracture of the distal humerus (green arrows).
If the fracture is minimally displaced (≤2mm), or nondisplaced, the patient can be managed conservatively, using a long-arm splint with the elbow flexed (60 to 90°) and forearm supinated [3, 4]. This immobilization technique will reduce muscle tension on the lateral condyle. Follow-up in 4-7 days for repeat radiographs and casting is recommended. With conservative treatment, up to 10% of fractures may develop a greater degree of displacement .
Pearl: If ≥2mm displacement, orthopaedic consultation for surgical stabilization is recommended. Significant laxity in valgus or varus may also require fixation.
Pearl: The lateral condyle fracture is immobilized in supination, as opposed to the supracondylar fracture, which is immobilized with the elbow flexed and forearm in a neutral or pronated position.