Lateral condylar fractures

Roll no. 13-18

 Anatomy:

• Consists of hourglass shaped trochlea and spherical

capitulum, which are situated between medial and
lateral humeral epicondyles.
• A trochlear groove spirals obliquely around trochlea
and divides it into medial and lateral portions.
• The indentation just above trochlea is called coronoid
fossa.
• A groove called capitulotrochlear groove seperates the
capitulum from trochlea.
• The indentation just above capitulum is called the
radial fossa.
 Pathoanatomy:
• Lateral condyle fractures are the 2nd most common elbow fractures in children after
supracondylar fractures.
• The fracture pattern is typically through the lateral metaphysis extending into epiphysis and
often extends into articular surface.The fracture line runs obliquely upwards from intercondylar
area.
• It is a Salter and Harris type lV epiphyseal injury.
• Because condylar epiphysis is largely cartilaginous,the
bone fragment may look deceptively small on x-ray,
than it is in reality.
 Mechanism of injury:
• The child falls on hand with elbow extended and forced into varus,
with forearm supinated.
• There are 2 theories suggested for forces acting to displace the
fracture, “pull-off” and “push-off”.
1. Pull-off theory: avulsion fracture of the lateral condyle that results
from the pull of common extensor musculature. The fragment is
rotated outwards along its vertical and horizontal axis, sometimes
even as much as 90⁰.
2.Push-off theory : compression of radial head into the lateral condyle causes fracture.
The fracture is important for 2 reasons:
1. It may damage the growth plate
2. It always involves the joint.
Classification
1. Anatomical location (Milch classification)

Type I: Fracture line lateral to trochlea through

the capitulotrochlear groove. Elbow is stable
(High Jupiter fracture).
Type II: Fracture line extends into apex of the
trochlea, elbow is unstable (Low Jupiter fracture).
2. Stages of Displacement-

a) Undisplaced
b) Displaced
c) Displaced and rotated
Clinical Features:
Patient complains of-
1. extreme pain
2. Swelling
3. loss of mobility at the elbow joint
4. Passive flexion of wrist (pulling on extensors)may be painful
There may be features suggestive of injuries to
the blood vessels and nerves.
Tenderness is present over the lateral epicondyle.
Radiological Features
When describing a lateral condyle fracture, it is
important to make comment about:

• Size of the osseous component

• Displacement(in mm)on internal oblique
• Associated elbow joint effusion
• Any additional injury
Internal oblique view