Multidetector computed tomography of pediatric lateral condylar fractures

The objective of this study was to compare lateral condylar fracture characterization using radiographs and multidetector computed tomography (MDCT) of the elbow and to evaluate outcomes in a group of children managed based on MDCT findings.

Unenhanced MDCT of the elbow with sagittal and coronal reformations was prospectively performed without sedation in 10 children between 1 and 16 years of age with lateral condylar fractures identified on frontal and lateral radiographs of the elbow. Two blinded readers reviewed all radiographs and MDCT images independently and in consensus. For the radiographs and MDCT images, readers graded the displacement of the lateral condyle fracture fragment and classified the fractures according to the Milch classification. Articular and epiphyseal cartilage integrity was assessed on MDCT. Patients were managed based on the consensus interpretation of the MDCT study. The frequency of interobserver agreement, discordant grading of fracture displacement and fracture classification between radiographs and MDCT images, and altered management based on the MDCT findings were determined.

Individual readers agreed on fracture displacement in 9 patients (90%) on radiographs and in all 10 patients (100%) on MDCT. Individual readers agreed on fracture classification in 4 patients (40%) on radiographs and in 9 patients (90%) on MDCT. In 4 patients (40%), grading of fracture displacement differed between the consensus interpretation of the radiographs and MDCT images. In 6 patients (60%), fracture classification differed between the consensus interpretation of the radiographs and MDCT images. All 3 patients with fracture displacement greater than 5 mm and 1 patient with fracture displacement between 2 and 5 mm demonstrated disruption of the articular and epiphyseal cartilage on MDCT. Two patients (20%) with fracture displacement near the surgical threshold of 2 mm had altered management based on the MDCT findings. All patients progressed to complete fracture healing, with no delayed displacement or other complications.

Multidetector computed tomography is a highly reproducible means of characterizing pediatric lateral condylar fractures and frequently demonstrates disruption of the epiphyseal and articular cartilage in patients with fracture displacement greater than 2 mm. The findings of MDCT may lead to altered treatment in patients with fracture displacement near the surgical threshold of 2 mm.