Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option?

Distal humerus condyle fracture in children is rare. These fractures often mislead the emergency physician or surgeon. However, treatment adapted to the degree of displacement achieves excellent clinical and radiographic results. The objective of this study was to clarify indications for conservative treatment of lateral humeral condyle fracture in children.

Twenty-two children who had sustained lateral humeral condyle fracture between January 2007 and January 2010 were reviewed in April 2010. At this consultation, the children underwent clinical and radiological examination. The Hardacre functional score was used to determine objective clinical outcome.

Conservative treatment was exclusive to cases of lateral condyle displacement equal to or less than 1mm. All other fractures were managed by surgical open reduction and fixation using cross-pinning. There was no statistically significant difference in clinical or radiological outcome between conservative and surgical management.

Lateral humeral condyle fracture is difficult to diagnose in children. The majority of poor results reported in literature relate to inadequate initial treatment. Given a radiological aspect of hemarthrosis of the elbow, the emergency physician prescribes multiple X-ray views of the affected elbow (anteroposterior, lateral and internal oblique). The clinical aspect of lateral humeral condyle fracture is often characteristic (ecchymosis facing the head of the radius). Nondisplaced or minimally displaced lateral humeral condyle fracture can be managed conservatively under close survey. However, secondary displacement under the cast is often difficult or impossible to detect, and outpatient surgery is therefore being increasingly indicated in our department.