Questions and Answers
What are pediatric lateral condyle fractures characterized by?
What mechanism of injury is associated with the pull-off theory?
Avulsion fracture of the lateral condyle due to pull of the common extensor musculature.
What is the significance of the Milch classification in lateral condyle fractures?
It classifies fractures based on the location of the fracture line in relation to the trochlear groove.
Type I Milch fractures are more common and result in an unstable elbow.
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The common symptoms of a pediatric lateral condyle fracture include lateral elbow pain and ______.
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What is the primary imaging method used to assess pediatric lateral condyle fractures?
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What is the recommended treatment for non-displaced fractures?
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What is the goal of treatment for nonunion in pediatric lateral condyle fractures?
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What is a common complication associated with pediatric lateral condyle fractures?
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Fishtail deformity is a common complication that can develop following a distal humeral fracture in childhood.
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Study Notes
Pediatric Lateral Condyle Fractures Overview
- Second most common elbow fractures in children, typically occurring around age 6.
- Higher risk of complications, including nonunion, malunion, and avascular necrosis (AVN).
- Most often classified as Salter-Harris IV fractures, involving the lateral condyle.
- Treatment varies based on degree of articular displacement; may require closed reduction and percutaneous pinning (CRPP) or open reduction.
Pathophysiology
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Mechanisms of Injury:
- Pull-off theory: Avulsion fracture due to pull of common extensor muscles.
- Push-off theory: Impact from a fall on an outstretched hand causing fracture.
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Fracture Characteristics:
- Extend proximally from the distal humerus metaphysis into the elbow joint.
- May compromise the stability of the elbow if extending into the trochlear groove.
Clinical Presentation
- Typical history involves a fall on an outstretched hand.
- Symptoms include lateral elbow pain, swelling, and potential subtlety in presentation if minimally displaced.
- Physical exam may show limited swelling and tenderness; lateral ecchymosis indicates an unstable fracture.
Imaging Techniques
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Radiographs: Essential for diagnosis, with AP, lateral, and oblique views recommended.
- An internal oblique view best visualizes fracture displacement.
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Additional Imaging:
- Arthrogram: Useful for minimally displaced fractures to assess cartilage surface.
- CT Scans: Rarely indicated unless fracture type is uncertain.
- MRI: Helpful for evaluating cartilage integrity and planning for non-unions but expensive and requires sedation.
Classification Systems
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Milch Classification:
- Type I: Fracture line is lateral to the trochlear groove; stable.
- Type II: Fracture line extends into the trochlear groove; unstable.
- Fracture Displacement Classification: Weiss et al.'s classification assesses displacement severity.
Treatment Options
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Nonoperative: Long arm casting indicated for <2 mm displacement.
- Immobilization in neutral rotation, weekly follow-ups and radiography to monitor for early displacement.
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Operative: Indicated for unstable fractures or those >2 mm displaced.
- Techniques include CRPP or open reduction, especially for significant displacement or joint incongruity.
- Postoperative care typically involves casting for 3-6 weeks.
Complications
- Generally worse outcomes compared to supracondylar fractures, with risks for:
- Stiffness: Most common complication, often self-resolving.
- Delayed Union: Fractures healing longer than 6 weeks, management varies based on displacement.
- Nonunion: Higher incidence than other elbow fractures; requires careful monitoring and may need surgical intervention.
- Cubitus Valgus and Tardy Ulnar Nerve Palsy: Due to physeal arrest or nonunion.
- AVN: Can occur 1-3 years post-fracture, risk influenced by surgical techniques.
- Fishtail Deformity: Contour abnormality of the distal humerus from skeletal development issues, potentially leading to functional impairment.
Anatomical Considerations
- Blood supply from the brachial artery and posterior anastomotic vessels.
- Lateral collateral ligament remains attached to proximal condyle fragment, critical for stability.
Late Presentation Management
- Treatment after 2-3 weeks may include reduction and ORIF or bone grafting.
- Associated risks include AVN and physeal arrest.
Surgical Techniques
- Closed Reduction and Pinning (CRPP): Aids in stabilization; optimal with divergent pin configuration.
- Open Reduction: Anterolateral approach preferred to preserve blood supply, ensuring visual confirmation of joint reduction.
Summary of Outcomes
- Nonoperative treatment has a notable nonunion rate, particularly for displaced fractures.
- Success of interventions and complications must be monitored closely in pediatric patients.
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Description
Explore the intricacies of pediatric lateral condyle fractures, a prevalent injury in children aged around 6 years. Understand their classification as Salter-Harris IV fracture patterns and the potential complications such as nonunion and malunion. This quiz will help consolidate your knowledge on the treatment approaches for these fractures.
