Acute Lateral Condyle Fractures of the Humerus

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Abstract

A good outcome in Acute Lateral condyle fractures can be achieved by proper assessment and protocol based treatment. Clinical assessment of fracture stability can be indirectly assessed by associated soft tissue swelling, fracture crepitus elbow joint stability. Radiographs will help in determining the displacement and thereby the fracture stability and classify the fracture. It should essentially include all three views, the Anteroposterior, 15 degrees Internal Oblique and Lateral views, during initial as well as during follow-up. If stability and pattern of fracture cannot be determined on radiographs, especially in very young children, MRI and Ultrasonography will aid in determining the stability of undisplaced fractures by looking at intact cartilage hinge. Stable fractures (Song's Grade 1 and 2) can be managed non-operatively. Weekly followup radiographs out of the cast for the first 2 weeks is essential as majority of undisplaced fractures get displaced within first 2 weeks. Displaced fractures are treated by closed or open reduction. Intra operative arthrogram can aid assessment of fracture fragment and its reduction. Two K-wires, one placed transversely and other obliquely at an approximate angle of 45-60 degrees, will be sufficient to provide good stability. A screw can be placed in older children with a large capitellum or a metaphyseal fragment. A low threshold for open reduction should be considered with an aim to achieve good articular reduction. The commonest concern is lateral prominence causing Pseudovarus deformity. It usually resolves over sometime.