LATERAL CONDYLE FRACTURE
(KIDS BROKEN ELBOW)
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A lateral condyle fracture is type of broken elbow that kids can get after falling.
Lets quickly review some anatomy of the elbow to better understand the injury. Our elbow is a joint where the arm bone (humerus) meets up with your two forearm bones (the radius and the ulna). The radius bone is on the lateral side (outside) of the elbow, while the ulna bone is on the medial side (inside). The lateral condyle is outer part of the humerus bone that makes contact with the radius bone at the elbow joint.
The lateral condyle can break after falling onto the elbow. It is often difficult to diagnose (more on this in the diagnosis section), and the break enters into the elbow joint, which means that this type of injury often needs surgery (also more on this later). So overall this injury can be a challenge to both diagnose and treat. But once its treated correctly the outcomes are good.
Diagnosing a a Lateral Condyle Fracture (Pediatric Broken Elbow)?
Lateral condyle fractures is injuried in kids around 6-10 years old and occurs after falling onto the elbow. Kids complain of pain along the outside of the elbow and pain with elbow motion.
A Lateral Condyle fracture is regarded among doctors as a fracture that is difficult to diagnose (and therefore is often missed).
To understand why, we need to first talk about how bones develop in kids. The bones of kids and adults are not the same. The bones in our arms and legs start out as a cartilage mold, in the same shape as our adult bones, and then get calcified, meaning calcium is laid down on top of the cartilage mold, to becomes the calcified bone that all adults have. This process of calcification does not occur all at once, and the calcification of our bone (also known as "ossification") doesn’t finish until we are in our teens. So kids that are walking around have bones that are at different stages of calcification based roughly on how old they are. The lateral condyle of the elbow is the last part of the elbow to ossify, often times not until the early teens in a kid.
The problem is that both calcified and non-calcified bones can break, but you only see the calcified part on x-ray. Therefore doctors often cannot use standard x-rays of the elbow to diagnose this injury in younger kids (as kids get older, and the bone becomes calcified, then this injury is easier to diagnose). Many times doctors must order special views of the elbow (called an oblique lateral x-ray) to better see this lateral condyle and determine if its broken. And when a lateral condyle fracture occurs, doctors often see only a small break in the calcified part of bone, but in reality the fracture is much larger and involves a portion of the uncalcified bone. Its like seeing the tip of the iceberg.
Treating a Lateral Condyle Fracture (Pediatric Broken Elbow)?
This is a type of injury that generally requires surgery as the rule, and non-surgical treatment is an exception.
Surgery is typically required because the break enters the elbow joint, so the bone needs to be realigned perfectly to minimize the risk of future arthritis.
Any movement of the fracture >2 mm requires surgery to fix.
Surgery will require putting the bone together, and then holding the fragments in place with two divergent pins, which will hold the bone while it heals for 3 weeks and will then be removed.
What is the long term outcome?
Why is it critical to identify this fracture and to fix it? Without repairing the bone, there is an increased risk that the bone will never heal (called "nonunion").
A nonunion increases the risk that a notable bump will form over the outside of the elbow (called a "bone spur"), which is not cosmetically pleasing, although this spurring can occur regardless of how the injury is treated (it is likely related to the severity of the initial injury). Also, a nonunion increases the risk that the elbow will bend outward more than normal, this is called cubitus valgus, and this abnormal bending can place a strain on one of the nerves traveling past the elbow (the ulnar nerve...it’s the nerve that gets whacked when you say you hit your funny bone), and over time pain, or dysfunction will develop as a result of that strain on this nerve (ulnar nerve palsy, see talk).
The nonunion doesnt have to be fixed if its seen on x-rays, however, it should be treated if a child develops symptoms as a result.
Additionally, if the joint surface is irregular from the break, there is a risk that arthritis can develop in the future, or there may be a problem with elbow mechanics.
Once the fracture is identified and fixed, kids typically have excellent outcomes after a few weeks of rest and immobilization to allow healing.
1) Launay F et al. Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Ped Ortho 2004; 24: 385-91. full article. k-wire fixation reduces nonunion risk.
2) Song KS et al. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. JBJS 2007; 89: 58-63. full article.
3) Shimada K et al. Osteosynthesis for the treatment of non-union of the lateral humeral condyle in children. JBJS 1997; 79: 234-40. full article. address nonunion if symptoms, it helps.
4) Bast SC, Hoffer MM, Aval S. Nonoperative treatment for minimally and nondisplaced lateral humeral condyle fractures in children. J Ped Ortho 1998; 18:448-50. full article. nonop if <2 mm displaced.
5) Pribaz JR et al. Lateral spurring (overgrowth) after pediatric lateral condyle fractures. J Ped Ortho 2012; 32: 456-60. full article. spurring risk related to initial displace and treatment.