Pediatric Lateral Condyle Fractures With Elbow Dislocation: Revisiting the Song Classification of the Most Severe...

Area of Science:

• Orthopedic Surgery
• Pediatric Traumatology
• Elbow Biomechanics

Background:

• Lateral condyle fractures are common pediatric elbow injuries with risks of malunion, nonunion, and avascular necrosis.
• Existing Song or Jakob classifications do not account for associated bony or soft tissue injuries like elbow dislocations.
• The incidence and outcomes of these complex injuries remain poorly understood.

Purpose of the Study:

• To describe the largest known case series of pediatric lateral condyle fractures with concomitant elbow dislocations.
• To characterize the incidence, presentation, treatment, and outcomes of these complex injuries.

Main Methods:

• Retrospective data collection of pediatric elbow fractures from November 2007 to October 2017 at a single center.
• Inclusion criteria focused on lateral condyle fractures with associated elbow dislocations.
• Data analyzed included injury mechanisms, presentation, surgical treatment, and patient outcomes.

Main Results:

• 30 of 492 lateral condyle fractures (6.1%) presented with elbow dislocation, predominantly in males (76.7%) aged 6.9 years.
• These injuries showed high rates of neurovascular deficits (23%), skin tenting (13.3%), and polytrauma (13.3%).
• All 30 cases underwent surgical treatment within 24 hours, with no reported avascular necrosis, nonunion, or fixation failure; however, 6.7% experienced pin tract infections and 40% required physical therapy for stiffness.

Conclusions:

• Lateral condyle fractures with ulnohumeral dislocation are unstable and require prompt inpatient surgical management.
• Current classification systems are inadequate for these combined injuries, potentially leading to underdiagnosis and delayed treatment.
• A proposed "Song 6" or "Jakob 4" classification is recommended to enhance identification and management, improving clinical awareness and patient outcomes.