Although rare, lateral condyle fractures occur more frequently than medial condyle fractures. The mechanism is usually a fall on the outstretched arm or direct force applied to the posterior aspect of the flexed elbow. Examination reveals swelling and tenderness laterally, crepitus, and limitation of movement. Radiographs show a fracture line extending from the supracondylar ridge through the intertrochanteric articular surface. There may be displacement of the distal fragment posteriorly and distally from the pull of the extensor muscles.
Treatment for undisplaced and minimally displaced fractures (< 2 mm) is immobilization in a long-arm splint with the elbow flexed, the forearm supinated, and the wrist dorsiflexed to decrease the tension from the extensor muscles. The patient should be referred in 2 to 3 days to an orthopedist. Surgery is indicated for displaced fractures.
Medial condyle fractures usually occur as a result of a fall on the outstretched arm or a direct force applied to the olecranon. Pain and swelling medially are prominent findings. There is also pain with flexion of the wrist through action of the flexors. The proximity of the ulnar nerve requires a careful neurovascular examination. The fracture line is oblique from the supracondylar ridge through the trochlear groove.
Treatment of undisplaced and minimally displaced fractures is immobilization in a long-arm posterior splint with the forearm pronated and the wrist flexed to relieve tension of the flexors originating from the medial epicondyle. Referral to an orthopedist is made in 2 to 3 days and active ROM may be started in 2 to 3 weeks. Displaced fractures require open reduction and internal fixation, usually with screws.
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