Lateral Condylar Elbow Fractures

Introduction

Fractures of the lateral humeral condyle are the second most common fracture of the paediatric elbow (John Harris et al The Radiology of Emergency Medicine, 3rd Ed, Williams and Wilkins, 1993, p 352). This page examines the radiographic demonstration of lateral condyle fractures of the elbow.

The Salter-Harris Classification

Salter notes that the lateral condyle fractures of the distal humerus are Salter Harris 4 fractures..

		<a class="external" href="http://books.google.com.au/books?id=oa6fDFuX-I8C&pg=PA523&lpg=PA523&dq=elbow+condyle+vs+epicondyle&source=bl&ots=lhiHITotg0&sig=YDhHTE7q_t_nQN0pcYGHEr0kFqo&hl=en&ei=wSBPSrS3Loj8sQPOvYWrDQ&sa=X&oi=book_result&ct=result&resnum=7" rel="nofollow" target="_blank">(Robert. Bruce. Salter ,</a> <a class="external" href="http://books.google.com.au/books?id=oa6fDFuX-I8C&pg=PA523&lpg=PA523&dq=elbow+condyle+vs+epicondyle&source=bl&ots=lhiHITotg0&sig=YDhHTE7q_t_nQN0pcYGHEr0kFqo&hl=en&ei=wSBPSrS3Loj8sQPOvYWrDQ&sa=X&oi=book_result&ct=result&resnum=7" rel="nofollow" target="_blank">Textbook. of Disorders and Injuries of the Musculoskeletal System. 3rd Ed, 1999, p523)</a>

Classification of Lateral Condyle Fractures

Classification of Lateral Condylar Elbow Fractures <a class="external" href="http://www.orthospot.com.au/papers.orthospot.com.au/fracupl_files/frame.htm" rel="nofollow" target="_blank">http://www.orthospot.com.au/papers.orthospot.com.au/fracupl_files/frame.htm</a>

This classification system is largely self-explanatory.

Case 1

This 6 year old girl presented to the Emergency Department after an unwitnessed fall. She was refusing to use her left arm and her left elbow was painful and swollen. She was referred for radiography of her left elbow.

This is an attempted AP elbow image that has been over-rolled into an oblique position. The image is under-exposed resulting in a low signal-to-noise ratio. There is a fracture of the lateral condyle of the distal humerus. This fracture involves the epiphysis, epiphyseal plate and lateral metaphysis/condyle. This is a Salter Harris IV fracture. The integrity of the reminder of the epihyseal plate is unclear. The lateral epicondyle looks suspect.

The lateral horizontal ray projection reveals significant posterior displacement of the fracture fragment.

Case 2

This 2 1/2 year old girl presented to the Emergency Department after an unwitnessed fall. She was refusing to use her left arm and her left elbow was painful and swollen. She was referred for radiography of her left elbow.

	This is an AP view image of the left elbow. There is a stage I lateral condyle fracture (arrowed).
	The lateral condyle fracture (arrowed) is seen posteriorly on the lateral image. There is an anterior and posterior fat pad sign.

Case 3

The details of this case are unknown

This is an axial left elbow image from circa 1958. The age of the patient and the mechanism of injury is unknown. The olecranon epiphysis is faintly visible which would provide an estimate of the child's age at around 11 years. There is a fracture of the lateral condyle.	This is a (pointless) comparison axial view. Note the wash marks associated with manual processing

Comment

This case demonstrates the potential value of the axial view of the elbow in cases of lateral condyle facture.

Case 4

This 81 year old lady presented to the Emergency Department after falling onto her right side. Her right elbow was painfull and swollen. She was referred for radiography of her right elbow.

	This is an AP view image of the right elbow. The medial epicondyle profile is irregular. There is a cortical step in the humeral articular surface. There is an abnormal smooth cortical density projected over the medial condyle.
	This is an external oblique view image of the right elbow. There is a fracture of the medial condyle (white arrows). The bony fragment is again noted (black arrow)
	The bony fragment is likely to be the capitellum which is rotated and displaced anteriorly.

Case 5

This 14 year old male presented to the Emergency Department with a painful left elbow. The mechanism of injury is unknown. He was referred for radiography of his left elbow.

	There is an anterior fatpad sign. There is a cortical breach demonstrated along the posterior aspect of the lateral condyle of the humerus.
	There is a fracture of the lateral condyle of the elbow. There is extensive associated soft tissue swelling.

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