Reduction and Fixation of Lateral Condyle Fractures of the Distal Humerus

Patient Selection

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  These fractures typically occur after falling onto outstretched hand or from a height
  
  
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  Jakob classification describes these fractures (Figure 1)
  
  
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  Treatment is based on extent of displacement, not location of fracture
  
  
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  Reserve nonsurgical management for nondisplaced or minimally displaced fractures (<2 mm)
  
  
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  Surgery is recommended for displaced (>2 mm) or rotated fractures
  

  
  
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    Closed reduction with percutaneous pinning may be indicated for minimally displaced fractures
    
    
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    Open reduction and internal fixation is warranted for significantly displaced (>4 mm) or unstable fragments

Preoperative Imaging

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  AP, lateral, and internal oblique views of elbow
  
  
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  Oblique view helps visualize true displacement
  
  
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  Often larger than visualized on plain films due to cartilaginous component
  
  
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  Hinging is difficult to assess on plain radiographs; MRI or magnetic resonance arthrography can help
  
  
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  Most treatment decisions are made from plain radiographs; advanced imaging rarely used because of cost and required patient sedation

Procedure

Special Instruments/Equipment/Implants

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  Fluoroscopic unit
  
  
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  Sterile tourniquet
  
  
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  Small right-­angle retractors for open reduction
  
  
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  Kirschner wires (0.062-­in); a small cannulated screw/washer can be used for older children with a bony fragment

Surgical Technique

Closed Reduction and Percutaneous Pinning