Lateral and Medial Humeral Condyle Fractures.pptx

Lateral and Medial Humeral Condyle Fractures in pediatrics

1. Lateral and Medial Humeral Condyle Fractures Dr. Mohammad Taqi Ehsani PGY2 of Orthopedics, FMIC June, 2024

2. Lateral and Medial Condyle Fractures lateral humeral condyle Fractures: transphyseal, intraarticular injuries. As such, they frequently require open reduction and fixation They are the second most common operative elbow injury in children, second in frequency only to supracondylar fractures. may be difficult to diagnose and have a propensity for late displacement, factors that make their treatment perilous Medial Condyle Fractures: Uncommon Injuries Mirror image of Lateral condyle fracture Radiographically, classification, treatment and potential complications

3. Anatomy anatomic considerations in lateral condyle fractures include the capitellum, lateral epicondyle, and soft tissues attached to it—namely, the extensors and supinator. Capitellum: first secondary ossification center of the elbow to appear, 2 years of age lateral epicondyle: the last, often not appearing until 12 or 13 years of age

4. Mechanism of Injury Lateral condylar fractures: are generally the result of a fall on an outstretched arm. The fall may produce varus stress that avulses the lateral condyle valgus force in which the radial head directly pushes off the lateral condyle Medial Condyle Fractures: Direct posterior blow to a flexed elbow Avulsion from a valgus hyperextension injury

5. Classifications several schemes for classifying lateral condyle fractures. The best known is the one described by Milch Milch’s type I: Radial-capitellar alignment is disrupted, but the ulnar-trochlear relationship is normal Milch’s type II: The fracture extends medial to the trochlear groove, thus making the ulnohumeral joint unstable. the radius and capitellum maintain their relationship. the Milch classification provides little prognostic information regarding treatment and potential complications.

6. Jakob’s classification of lateral condyle fractures based on the presence of an intact articular hinge Type A: the fracture extends through the metaphysis and physis, but a portion of the articular cartilage remains intact. These fractures are stable, will not displace, and heal with immobilization. Type B: the fracture extends completely through the articular surface. Radiographically, this fracture may be impossible to distinguish from the type A fracture. However, it is potentially unstable and at risk for late displacement and delayed union or nonunion. Type C: , grossly displaced lateral condylar fragment (may be significantly rotated)

7. Weiss’s classification of lateral condyle fractures the most useful classification system to date after retrospectively reviewing 158 operative lateral condyle fractures based on amount of displacement at the metaphyseal fragment Type I: displacement <2 mm Type II: displacement between 2 and 4 mm with articular cartilage intact Type III: displacement >4 mm with articular cartilage disrupted.

8. Medial Condyle Fracture Classification Similar to Lateral condyle fractures Milch Classification: Milch Type 1: the fracture exits at the trochlear notch Milch Type 2: the fracture extends more laterally through the capitellar ossification center Kilfoyle’s Classification: Nondisplaced: <2mm Minimally displaced: 2-4mm Displaced: >4mm

9. Diagnosis Careful history Pain and decreased ROM Tenderness Radiographically (AP, Lat) often difficult to distinguish between transphyseal fractures and lateral condyle fractures. Both may have a posteriorly based Thurston-Holland fragment on the lateral radiograph (triangular portion of the metaphysis remaining with epiphysis in physeal fracture)

10. Diagnosis In transphyesal fracture: radial head-capitulum relationship remains intact more likely to exhibit posteromedial displacement In displaced lateral condyle fracture: the capitulum laterally displaced exhibit posterolateral displacement Oblique radiographs or arthrograms: minimally displaced fractures CT (if the diagnosis is in doubt)

11. Differential Diagnosis Transphyseal fractures Minimally displaced supracondylar fracture Radial neck fracture nursemaid’s elbow infection

12. Treatment depends on the amount of fracture displacement Weiss’s classification of lateral condyle fractures Kilfoyle’s Classification of Medial condyle fractures Nondisplaced: <2mm Closed Reduction Minimally displaced: 2-4mm Closed Reduction+ Percutaneous Pinning Displaced: >4mm Open Reduction+ Fixation

13. Complications Cubitus Varus Delayed union (does not heal with 6 weeks of immobilization or an untreated fracture that is initially seen more than 2 weeks (but by convention <3 months) after the injury) Nonunion (not healed within 3 months) Growth arrest, fishtail deformity Stiffness AVN Lateral spur formation (Lateral Condyle) Ulnar neuropathy (Medial Condyle)