Pediatric Lateral Humeral Condyle Fractures

Excerpt

Lateral humeral condyle fractures are the second most commonly encountered pediatric elbow fractures next to supracondylar fractures (see Image. Lateral Humeral Condyle Fracture). These injuries are unique, being intraarticular but vulnerable to displacement and nonunion owing to the forearm extensors' pull on the lateral epicondyle near the condylar area. These fractures can result in complications like elbow deformity if not appropriately managed.

A history of a fall onto an outstretched hand is common. Swelling, pain, restricted range of motion, and localized tenderness of the elbow are the usual presenting features. Lateral elbow ecchymosis may also be observed. Several classification systems have been developed to aid management, with a 2 mm displacement considered the surgical fixation cutoff. Displaced fractures are at a higher risk of nonunion. Malunion, cubitus varus, avascular necrosis, and post-operative infection are recognized complications following surgery.

Anatomy of the Humerus

The arm bone or humerus is the largest upper limb bone (see Image. Upper Arm Anatomy). The humerus articulates with the scapula at the glenohumeral joint (shoulder) and the radius and ulna at the elbow joint. The proximal humeral segment comprises the head, greater and lesser tubercles, and surgical and anatomical necks. The humeral shaft has the deltoid tuberosity laterally and radial groove posteriorly. The arm bone widens distally, forming the lateral and medial supracondylar ridges superior to the elbow joint. Further distally are the angular-shaped lateral and medial epicondyles, flanking the condylar area. The humeral condyle forms the elbow joint with the radius and ulna and comprises the trochlea, capitulum, and olecranon, coronoid, and radial fossae.

The head is the part of the arm bone that articulates with the scapula's glenoid cavity. The anatomical humeral neck marks the attachment site of the glenohumeral joint capsule. The surgical neck is a slightly narrowed arm bone section distal to the humeral head and tubercles. The greater tubercle is a bony prominence at the lateral side of the humerus, while its anterior counterpart is the lesser tubercle. The intertubercular sulcus (bicipital groove) lies between the tubercles and houses the tendon of the long head of the biceps.

The deltoid tuberosity is the deltoid muscle's attachment site on the humeral shaft. The radial groove houses the radial nerve and profunda brachii artery. The lateral epicondyle lies lateral to the humeral condyle and provides an attachment site for the forearm extensors. Meanwhile, the medial epicondyle is a forearm flexor attachment site located medial to the humeral condyle.