Lateral Humeral Condyle Fracture Clinical Presentation

Updated: Oct 14, 2020
  • Author: Stefanos F Haddad, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Presentation

History

Children with lateral humeral condyle fractures usually have a history of a fall onto an extended arm. They typically present with pain and associated elbow swelling. 

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Physical Examination

Physical examination demonstrates a swollen elbow, pain that is greatest over the lateral condyle, and refusal of the patient to actively move the elbow. Occasionally, crepitus is present in an unstable fracture pattern. Significant deformity may indicate an elbow dislocation.

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Classification

In 1964, Milch described an anatomic classification system that divided lateral condyle fractures into the following two types on the basis of the location of the fracture line [4, 11] :

  • Type I (less common) - The fracture extends through the ossification center of the lateral condyle and exits at the radiocapitellar groove (see the first image below), producing a Salter-Harris type IV fracture pattern; the lateral crista of the trochlea remains intact and therefore has less tendency to dislocate laterally
  • Type II (more common) - The fracture extends across the physis and exits through the apex of the trochlea (see the second image below), producing a Salter-Harris type II or type IV fracture pattern; the lateral crista is in the fracture fragment, and the trochlea is no longer intact, rendering the elbow unstable
Milch type I fracture pattern. Milch type I fracture pattern.
Milch type II fracture pattern. Milch type II fracture pattern.

In 1975, Jakob described a classification system based on displacement of the fracture fragment, which divided these injuries into three stages as follows [12] :

  • Stage I - The fracture is nondisplaced with an intact articular surface
  • Stage II - The fracture extends through the articular surface, and there is moderate rotational displacement
  • Stage III - There is complete displacement and capitellar rotation with elbow instability

Some authors believe that the Jakob classification system is more useful than the Milch system.

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