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

Nonsurgical Management

Nondisplaced Fractures

Indications. Lateral condyle fractures that are minimally displaced (Weiss type 1; Song stage 1 to 3) and have well-visualized congruent joint surfaces, perhaps, pose the biggest challenge for the surgeon because the stability of the fracture fragment is unknown based on the initial plain radiographs. Most authors agree that fractures with ≤2 mm of displacement can be treated initially with immobilization alone with careful follow-up to identify further displacement.[2,4,5,9] However, reportedly up to 14.9% of fractures will further displace despite immobilization,[3,14,15] making it critical to emphasize the importance of adherence to follow-up recommendations.

Treatment. A long arm cast is applied with the elbow positioned at 90° of flexion and the forearm positioned in neutral rotation. Follow-up radiographs are taken approximately 4 to 8 days after the initial injury, once the swelling has subsided,[3,4] and weekly for 2 to 3 weeks thereafter to monitor for further displacement. It is our preference to order AP/lateral and internal oblique views at each follow-up visit; if the fracture fragment is not adequately visualized because of overlying fiberglass or plaster, the radiographs are repeated after cast removal. For fractures that show no further displacement, cast immobilization is continued for 4 to 6 weeks, with discontinuation of casting based on the extent of bridging callus[3] across the metaphysis and lack of tenderness over the fracture site. ROM can be initiated immediately after removal of the cast with slow progression to full activity over the course of 6 weeks.

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