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

Disclosures

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

In This Article

Fracture Classification

Several classification schemes are used to describe lateral condyle fractures. The Milch and Jakob classifications have traditionally been used,[1,2] but the authors favor the more recently described Song and Weiss classifications because these are both descriptive and also help guide treatment.[4,5]

Song

Song et al[4] proposed a classification scheme based on fracture displacement, pattern, and stability. Using this scheme, the authors created a treatment algorithm for lateral condyle fractures with a special emphasis on using internal oblique radiographs to guide management. Stage 1 fractures have ≤2 mm displacement, a small metaphyseal fracture line, and are stable. Stage 2 fractures have ≤2 mm displacement, a lateral fracture gap, with indefinable stability. Stage 3 fractures have ≤2 mm displacement, lateral and medial fracture gaps, and are unstable. Stage 4 fractures have >2 mm displacement, no rotation of the fracture fragment, and are unstable. Stage 5 fractures have >2 mm displacement, rotation of the fracture fragment, and are unstable. In their prospective study, the authors treated 63 fractures deemed as unstable, which included fractures that extended into the articular surface (stage 3) or had >2 mm displacement with or without rotation (stage 4 or 5) with either a closed or open reduction with pin fixation.[4] The authors reported that 73% (46/63) were successfully reduced with good results, and no serious complications occurred.[4]

Weiss

Weiss et al[5] described a classification scheme based on displacement and articular surface congruency as determined by elbow arthrography for select fractures. Type 1 fractures have <2 mm displacement with articular surface congruency. Type 2 fractures have ≥2 mm displacement with articular surface congruency. Type 3 fractures have ≥2 mm displacement with an incongruent articular surface. This classification system may be used for surgical decision-making and is preferred by the authors.[5] In a retrospective study of 158 patients with type 2 and 3 lateral condyle fractures, all patients underwent surgical intervention, either by closed reduction or open reduction combined with pin fixation. The authors reported an overall complication rate of 25% (39/158).[5] It was noted that the fracture's classification and subsequent treatment predicts the risk of complications; type 2 fractures were statistically less likely to develop complications compared with type 3 fractures, 11% and 34%, respectively (P < 0.03).[5] The authors further delineated that all type 2 fractures had <4 mm of displacement with articular congruency, whereas all type 3 fractures had ≥4 mm of displacement without articular congruency.[5] This helps with intraoperative decision-making because patients with ≥4 mm of displacement should proceed to surgical intervention without the use of a preoperative or intraoperative arthrogram as the articular surface will most likely be disrupted.

processing....