Minimally Displaced Lateral Condyle Fractures of the Elbow: Treatment with Arthrography and Percutaneous Cannulated Screw Fixation
Lateral condyle fractures of the elbow in children are relatively common. Typically classified as Salter-Harris IV injuries, they cross the distal humeral physis and may enter the elbow joint through the trochlea. When displaced, they must be anatomically reduced to avoid malalignment and minimize the potential for posttraumatic arthritis at the joint surface. When nondisplaced, they are amenable to conservative management, typically with a long arm cast. Fractures with indeterminate displacement can be assessed either by using an MRI scan or arthrography. An assessment in the operating room using an elbow arthrogram also allows percutaneous fixation to be completed in the same setting. This chapter discussed the indications for elbow arthrography and percutaneous fixation of minimally displaced lateral condyle fractures, as well as the risks and benefits of fixation using cannulated screws versus percutaneous pins, and the typical postoperative management when using percutaneous cannulated screws.
A 9-year-old boy fell while riding his bike and injured his left arm. He had immediate pain, swelling at the elbow, and difficulty moving the arm. Radiographs in the emergency department revealed a minimally displaced lateral condyle fracture. He was splinted and scheduled for assessment in the operating room with an elbow arthrogram and possible internal fixation. After a discussion of options with the family, the patient was given a general anesthetic, and a left elbow arthrogram was performed. The arthrogram revealed an intact cartilaginous joint surface, and percutaneous fixation was performed using a 4.0 mm cannulated screw. Postoperatively, the patient was maintained in a long arm cast for 6 weeks, followed by physical therapy to regain range of motion and strength for another 6 weeks. The patient healed the lateral condyle fracture well, and the cannulated screw was removed under a second anesthetic as an outpatient procedure about 6 months later.