LATERAL CONDYLE FRACTURE
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Lateral Condyle Fracture
A Lateral Condyle Fracture is the second most common pediatric elbow injury. Injuries like these involve a higher risk of nonunion, malunion, and AVN than any other fractures in the pediatric elbow. The Humerus is the long bone of the upper arm that extends from the elbow to the shoulder. And lateral condyle fracture is a fracture in the lower part of this bone, near the elbow.
It is a common injury in younger children. It often occurs because of falling straight onto an outstretched hand or a direct blow to the elbow. Also, this could happen in falls from scooters, monkey bars, skates, etc.
Types of Lateral Condyle Fractures
Milch first described lateral condyle fracture patterns. For example, Milch type 1 fractures extend through the ossification center of the trochlea. Milch type 2 fractures extend through the medial to the ossification center. However, this classification system does not provide any prognostic or treatment guidance.
Jakob et al categorized fractures depending on fracture displacement. While type I is nondisplaced with an intact articular surface, type II extends through the articular surface. Type III is complete displacement.
Also, Weiss et al. categorized this injury depending on displacement and integrity of the articular surface.
How is this Injury Treated?
Usually, in these injuries, either the fractured bones have separated/displaced or nondisplaced ( in which the bone fragments did not move). The second kind of fracture can be hard to find on x-ray since, in some cases, the fracture line is hardly visible. Surgery is usually necessary when the bone is widely displaced. In surgery, the doctors will move the bone and set it back to its normal position with pins or screws. Thus, it can heal properly.
Your child will have to wear a cast for protection. To leave room for swelling doctor will probably start with a split cast on the arm. In this case, he will tape the sides of the cast with cloth medical tape. These tapes are available at the pharmacy. And you can replace them if the tape starts to peel off. Also, you may use cloth athletic tape or duct tape if your child doesn’t have a latex allergy.
The cast sits firmly in place from the inside. That is why it won’t fall apart even if the tape starts to peel. Doctors usually do not use waterproof material for these first casts because of swelling. In Particular, swelling in the fingers is quite common. Your child might need help with keeping their arm and hand lifted. The arm should be resting above the heart to help with swelling.
Finally, treating this type of broken bone takes the experience and expertise that our doctors at Medical City Children’s Orthopedics and Spine Specialists have. If not us, we strongly suggest you see someone who has treated this condition on a regular basis.
QUESTIONS AND ANSWERS
What is a lateral condyle fracture, and how does it happen in children?
- Lateral Condyle Fracture: A lateral condyle fracture is a break in the bony prominence on the outer side of the lower end of the humerus bone (the upper arm bone) where it forms the elbow joint. It is one of the most common elbow fractures in children.
- Mechanism: Lateral condyle fractures often result from a fall onto an outstretched hand with the elbow slightly bent. The force from the fall is transmitted to the lateral condyle, leading to a fracture. They are frequently seen in children because their bones are still developing and are more susceptible to this type of injury.
How is a lateral condyle fracture in a child diagnosed and treated?
- Diagnosis: Lateral condyle fractures are typically diagnosed through a physical examination and imaging studies, such as X-rays. The fracture is classified based on its displacement and alignment.
- Treatment: The treatment approach depends on the severity of the fracture:
- Non-Displaced Fractures: Non-displaced fractures may be treated with immobilization in a cast or splint for several weeks, allowing the bone to heal.
- Minimally Displaced Fractures: Minimally displaced fractures may require closed reduction (realigning the bone without surgery) and casting.
- Severely Displaced Fractures: Severely displaced fractures may require surgical intervention, such as open reduction with internal fixation (ORIF) to reposition and stabilize the fracture with pins or screws.
- Rehabilitation: Physical therapy is an important part of recovery for children with lateral condyle fractures. It helps restore elbow function, strength, and range of motion.
What are the potential complications and long-term outcomes of lateral condyle fractures in children?
- Growth Disturbance: One of the main concerns with lateral condyle fractures is the potential for growth disturbance in the affected bone. If the fracture involves the growth plate, there is a risk of unequal growth, leading to issues like limb length discrepancy.
- Stiffness or Reduced Range of Motion: Depending on the fracture and treatment, some children may experience stiffness in the elbow or a reduced range of motion. Early and appropriate rehabilitation can help minimize these issues.
- Nonunion or Malunion: In rare cases, fractures may not heal properly (nonunion) or may heal in a misaligned manner (malunion). Timely and appropriate treatment helps reduce the risk of such complications.
Children with lateral condyle fractures require careful evaluation, treatment, and follow-up to ensure proper healing and minimize the risk of complications. Consulting with a pediatric orthopedic specialist is important to determine the best course of action based on the specific fracture’s characteristics and the child’s age and growth stage.
When children break bones, parents need to take them to the very best doctors. At the Medical City Children’s Orthopedics and Spine Specialists, we are the best. We specialize in children and their bones.
Management Of Different Types Of Lateral Condyle Fractures
Type – I
The degree of displacement will determine the management. Type-I fracture, with less than 2 mm of displacement, is easy to manage without any operation with cast immobilization. The recommended method of immobilization is a long arm cast or splint with the elbow flexed at 60/90 degrees. The patient should return to the clinic within one week for follow-up radiographs out of the cast/splint to evaluate further displacement.
While Marcheix et al did not come up with any further displacement, another study by Pirker et al demonstrated that 5 of 51 have increased displacement needing surgery. Casting for four weeks is usually sufficient for this kind of injury. However, radiographs will be necessary to confirm healing before discontinuing cast treatment.
Type – II
There might be variations in management depending on increased displacement. Doctors successfully treat type II fractures with an intact articular hinge with closed reduction and pinning. Surgeons use 2 or 3 pins and percutaneous or subcutaneous while there are pros and cons related to each option.
An anatomic articular reduction is crucial to get a good clinical outcome. Considering that surgeons should have a low threshold for open reduction. Arthrography is essential in evaluating the reduction in the course of surgery.
Type III
To manage Type III fractures, doctors use open reduction and pinning. Also, they use the lateral approach and the dissection of the fracture should be nearer to the forepart of the joint. To prevent Avascular Necrosis it is crucial to avoid soft tissue dissection of the posterior aspect of the fragment. The primary goal of the reduction is Articular Congruence.
After an operation for Type II and III fractures, experts place the patient in a long arm cast or splint with the elbow at 90 degrees of flexion and the forearm in a neutral position. They will generally remove the cast and pins at four weeks if the sign of healing is obvious on radiographs. Then begins the early active range of motion.
Will my Child be in Pain?
In the first few days through the first week, soreness is usually at its worst. Doctors often recommend acetaminophen (Tylenol®) or ibuprofen (Advil®) to treat pain from soreness. However, always discuss allergies your child may have before having over-the-counter medication. Experts often prescribe a small amount of pain medicine post-surgery if necessary.
Can my Child Stay Active with a Lateral Condyle Fracture?
Despite the cast providing some protection, a direct blow to the arm or elbow could make the fracture worse. To stay safe, your child should avoid doing any activities with a risk of falling or taking a direct hit to the arm.
Such activities include:
- Contact sports such as basketball, hockey, soccer
- Playing on playground structures such as jungle gyms or swing sets
- Ice skating, horseback riding, or skiing
How Long Should My Child Stay Away from Sports?
We evaluate each patient and make recommendations depending on how the fracture looks. Also, we assess the potential injury risks of the sport your child loves to play. This kind of injury may keep patients away from playing contact sports for two to three months.
Will my Child Need Treatments or Physical Therapy after Casting?
Usually, most patients do not require physical therapy. Your child will gain complete strength and movement within one or two weeks after the casting ends. However, if there is any trouble restoring full motion, doctors might recommend therapy.
What is the Right Time to Follow Up?
During the first two weeks, experts often see patients once a week for X-ray checks. All the muscles in the arm put pressure on the bone even though your child is in a cast and unable to move. This tension tends to make the bone set out of the right position. Specialists carefully monitor this and treat it early if it happens.
If the first cast was split and everything looks alright in the first week of the appointment, experts overwrap the cast. This means adding a new layer of casting material to close off the cast. This prevents it from getting too loose as swelling is relieved.
How Long Will My Child Need a Cast for a Lateral Condyle Fracture?
Commonly the timeline for this injury is four to six weeks in a long arm cast. After that, your child will again go to see the doctor who will remove the cast and do an x-ray. Also, they will remove pins from surgery once the bone heals and is stable. However, if they have used screws instead, removing them may not be necessary.
When Should I Contact the Doctors?
Get immediate medical attention in the following cases:
- Pain increasing quickly without warning
- Swelling for no reason
- New redness and warmth being generated around the wrist
- New fevers, chills, nausea, sick feeling
- Pain that does not get better even after taking ibuprofen (Advil®), acetaminophen (Tylenol®), etc.
- Inability to wiggle fingers, numbness
All the above symptoms could be signs of a different problem. In that case, you must take your child to the clinic or the emergency department. Proper medical attention, a little patience, and care – and your child will be all right.
Why See the Doctors at Medical City Children’s Orthopedics and Spine Specialists
Every year, hundreds of children, teens, and young adults with fractures of all sorts and degrees of complexity are treated by the orthopedics and fracture experts at Medical City Children’s Orthopedic and Spine Specialists with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. Furthermore, our expertise in children allows us to precisely diagnose diseases affecting the growing musculoskeletal system and establish appropriate treatment plans. Orthopedic injuries that require immediate medical attention but are not serious enough to warrant emergency room care are treated by our orthopedic specialists. We invite you to give us a call and make an appointment. We specialize in children and are experts in treating them for musculoskeletal conditions.
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Footnote:
Call 214-556-0590 to make an appointment.
Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.