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.

Physical Examination

Ecchymosis at the lateral aspect of the elbow is often indicative of an unstable fracture that may have caused a tear in the brachioradialis aponeurosis. Localized tenderness to palpation is typically present at the fracture site with resistance to passive and active elbow range of motion (ROM). Purposeful palpation of the entire extremity is needed to rule out any concomitant injuries. A thorough neurovascular examination should be performed assessing for digital sensation, hand motor function, and peripheral pulses.

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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.