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Lateral Humeral Condyle Fracture Workup

  • Author: Janos P Ertl, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Feb 10, 2016
 

Imaging Studies

Radiography

Obtain standard anteroposterior (AP), lateral, and oblique radiographs in patients with a suggested elbow fracture (see the first and second images below). Obtain a comparison view of the contralateral (ie, uninjured) elbow as a control or template (see the third image below). This is especially helpful when ossification is not yet complete.[13]

Lateral condyle fracture. Note subtle fracture lin Lateral condyle fracture. Note subtle fracture line.
Lateral condyle fracture, additional view. Fractur Lateral condyle fracture, additional view. Fracture may be subtle and can sometimes be missed.
Normal contralateral elbow. Normal contralateral elbow.

Varus stress views have been recommended in questionable cases. However, these are painful to the patient and may displace a previously undisplaced fracture. Reserve stress views for the operating room, where they can be performed under fluoroscopy and can assist in the decision of open versus percutaneous treatment.

The accuracy of radiographic measurements in assessing displacement in lateral humeral condyle fractures has been questioned. Radiography may not be sensitive enough to detect displacement. Knusten et al reported a failure to detect displacement of 2 mm when the upper extremity is positioned for an internal oblique lateral radiograph.[14] They found that the true fracture displacement measurements were larger than radiographic displacement measurements, with differences ranging from 1.6 to 6 mm.

The reduced precision of radiography may affect fracture management. For example, a patient who requires surgery (as indicated) may be treated with immobilization if radiography fails to illustrate the true fracture displacement (see Treatment).

Patients with a high clinical suspicion of a displaced fracture may require further diagnostic studies (eg, magnetic resonance imaging [MRI] or arthrography).

Arthrography

Arthrography assesses the size of the cartilaginous fragment and the articular displacement and can help in decision making in difficult cases. However, this study is difficult to achieve without sedation and should be reserved for the operating room.

Magnetic resonance imaging

MRI (see the images below) may be used to determine the size and degree of displacement. It has taken the place of preoperative arthrography in cases that are difficult to manage. Sedation may be required.

MRI demonstrating Milch type I fracture pattern. MRI demonstrating Milch type I fracture pattern.
MRI demonstrating Milch type II fracture pattern. MRI demonstrating Milch type II fracture pattern.
 
 
Contributor Information and Disclosures
Author

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

William J Brackett, MD Research Assistant, Department of Orthopedic Surgery, Indiana University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Mark D Lazarus, MD Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

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Normal contralateral elbow.
Lateral condyle fracture. Note subtle fracture line.
Lateral condyle fracture, additional view. Fracture may be subtle and can sometimes be missed.
MRI demonstrating Milch type I fracture pattern.
MRI demonstrating Milch type II fracture pattern.
Intraoperative fluoroscopic radiograph of Kirschner-wire fixation of lateral condyle fracture.
Kirschner-wire fixation.
Diagram of intact distal humerus.
Milch type I fracture pattern.
Milch type II fracture pattern.
 
 
 
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