Lateral Condyle Fractures
These injuries account for approximately 20% of pediatric elbow injuries and involve a fracture through one of the growth centers of the distal humerus and into the elbow joint.
Sometimes these fractures can be undisplaced (crack in the bone without any shift) however, since the muscles that extend the wrist originate on the lateral condyle, the muscular pull can shift the fracture.
For truly undisplaced fractures we immobilize the child in a cast, watching carefully for movement in the fracture. If there is uncertainty regarding displacement, we typically take these children to the operating room. We inject a water-based xray contrast dye into the joint and look at the joint surface, which is almost universally cartilage and not visible on plain xrays. Often we will place pins or screws in the bone to stabilize the fracture and allow for healing.
If there is a large amount of shift in the fracture, these elbows require a formal incision and an "open reduction" to reposition and stabilize the bone with pins or screws, followed by immobilization in a cast for numerous weeks until healing is achieved.
Some of the unique complications of this injury include non-union (the fracture does not heal), avascular necrosis of the capitellum (loss of blood supply to the affected growth center), and angular deformities at the elbow from either overgrowth or growth arrest at the lateral condyle. Note that this list is not a comprehensive list of complications.