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

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Trauma Surgery

Background:

• Lateral condyle fractures are common pediatric elbow injuries with risks of malunion, nonunion, and avascular necrosis.
• Existing classification systems (Song, Jakob) do not account for associated injuries like elbow dislocations.
• The incidence and outcomes of these complex fracture-dislocation injuries are poorly understood.

Purpose of the Study:

• To report the largest case series of pediatric lateral condyle fractures with concomitant elbow dislocations.
• To characterize the incidence, presentation, and outcomes of these complex injuries.
• To advocate for improved classification and management strategies.

Main Methods:

• Retrospective review of pediatric elbow fractures treated at a single center from November 2007 to October 2017.
• Identification of lateral condyle fractures with associated elbow dislocations.
• Analysis of injury, treatment, and outcome data.

Main Results:

• 30 of 492 (6.1%) lateral condyle fractures involved concomitant elbow dislocations.
• Injuries predominantly affected males (76.7%) with a median age of 6.9 years, often from intermediate-energy mechanisms.
• High rates of neurovascular deficits (23%), skin tenting (13.3%), and polytrauma (13.3%) were noted. All 30 cases underwent prompt surgical treatment with no reported AVN, nonunion, or fixation failure, though 40% required physical therapy for stiffness.

Conclusions:

• Lateral condyle fractures with ulnohumeral dislocation are distinct, unstable injuries requiring urgent inpatient management.
• Current classifications are inadequate for these combined injuries, potentially leading to underdiagnosis and delayed treatment.
• A proposed "Song 6" or "Jakob 4" classification would enhance identification and management, improving clinical awareness and patient outcomes.