Lateral Humeral Condyle Fracture Workup

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

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).

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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.

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Magnetic Resonance Imaging

MRI may be used to determine the size and degree of displacement (see the images below). 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.
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