Current Concepts in the Treatment of Lateral Condyle Fractures in Children

Joshua M. Abzug, MD; Karan Dua, MD; Scott H. Kozin, MD; Martin J. Herman, MD

J Am Acad Orthop Surg. 2020;28(1):e9-e19.

Summary

Lateral condyle fractures are the second most common elbow fracture in the pediatric cohort. A trial of nonsurgical management is warranted in patients with ≤2 mm of fracture displacement and congruency of the articular surface. Closed reduction and percutaneous fixation should be used for fractures with displacement >2 to 4 mm, and ORIF with displacement ≥4 mm, because the articular surface is incongruent if closed reduction fails. Surgical intervention can lead to numerous complications including malunion, fishtail deformity, and osteonecrosis.

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Table 1. Hardacre Outcome
Outcome	Symptoms/Results	ROM	Carrying Angle
Excellent	None	Full	No change
Good	Pain	Loss of <15° extension	Minimal
Poor	Arthritis, ulnar neuritis, nonunion, osteonecrosis	Disabling loss of motion	Alteration in carrying angle

ROM = range of motion

Table 2. Dhillon Scores
Pain/Weakness	ROM	Carrying Angle	Score
None	0°-140°	Valgus 7°-10°	3
Occasional	>15°-125°	Valgus < 20°, varus < 0°	2
After heavy work	>30°-110°	Valgus 20°-30°, varus 0°-15°	1
With normal activity/motor or sensory loss	<30°-110°	Valgus > 30°, varus > 15°	0

ROM = range of motion
Functional grading (pain/weakness + ROM): Excellent: 6 points, Good: 5 points, Fair: 4 points, Poor: <4 points. Overall grading: Excellent: 9 points, Good: 7 to 8 points, Fair: 5 to 6 points, Poor: <5 points.