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Lateral condyle fractures in children: evaluation of classification and treatment
E C Mirsky1, E H Karas, L S Weiner
1Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10029, USA.
Objective:
To compare intra-operative findings of fractures of the lateral condyle of the humerus in children with existing pre-operative radiographic classification.
Design:
Prospective, consecutive.
Setting:
Large urban hospital.
Patients:
25 consecutive displaced lateral condyle (humerus fractures) in 25 children diagnosed on biplanar radiographs.
Intervention:
Open reduction and internal fixation through a lateral approach to the elbow.
Main Outcome Measurements:
Anatomic variations of the lateral condyle of the distal humerus based upon intra-operative observations; comparison of findings with pre-operative radiographic classification.
Results:
Three anatomic types were identified: 1) nine fractures exited on the medial side of the capitellum in the capitello-trochlear groove (36%), 2) eleven fractures exited beyond the capitello-trochlear groove through the trochlear epiphysis (44%), and 3) five fractures extended across the physis medially (20%). No fracture appeared to transverse the ossified portion of the capitellum (Milch Type I). The Milch anatomic classification was found to be inaccurate in 52% of the fractures.
Conclusion:
Intraoperative findings did not correlate with the presumed preoperative radiographic diagnosis in the majority of cases. A heightened awareness of the limitations of this traditional classification system is required for operative decision.