Peak age: 6 years

17% of all pediatric distal humerus fractures

2nd most common elbow fracture in children

Mechanism of Injury

Varus stress on a supinated forearm: supination puts supinator muscle on stretch causing avulsion mechanism

"Push vs. Pull": the former is an axial load transmitted through forearm / radial head / into capitellum and lateral condyle, "pushing" fragment off distal humerus

Milch Classification

Type I: fracture line extends from lateral condyle through capitulotrochlear groove

Stable elbow: trochlea intact

Salter-Harris IV

Less common type

Milch Classification

Type II: fracture line extends from lateral condyle through apex of trochlea

Unstable elbow

Salter-Harris II

More common type

Jakob Classification

Stage I: nondisplaced (<2mm), articular surface intact

Stage II: 2-4mm "hinged" displacement of metaphyseal fragment, articular surface intact

Stage III: completely displaced, distal fragment rotated; unstable elbow joint

Horn et al JPO 2002: "integrity of the cartilage hinge at the distal humeral epiphysis determines stability". Only metaphyseal component of lateral condyle fractures visualized on x-ray

Nonoperative Treatment

Jakob Stage I

Long arm cast with 90° elbow flexion, neutral forearm

Follow up with x-rays 2-3 times in first 3 weeks

D/C cast in 4 weeks

Finnobogason et al JPO 1995 followed 112 stage I lateral condyle fractures and found that fractures which did not extend into the elbow joint were stable and not at risk for displacement.

Jakob Stage II or III:

OR, Flouroscopy and/or arthrography to determine nature of fracture

Stage II: CRPP


CRPP Technique:

Two smooth 0.062 K-wires inserted into lateral condyle

Pins diverge in metaphysis

Range elbow, varus and valgus stress

Open technique:

Incision: anterior to lateral condylar ridge

Traumatic "rent" in extensor mass: enlarge traumatic opening to visualize fragment

DO NOT strip posterior aspect of fragment

Pin as mentioned above


Overgrowth: 40% of lateral condyle fractures

Lateral spur: 28% of lateral condyle fractures

coronal rotation of distal fragment laterally displaces a periosteal flap on distal fragment

long-standing varus deformity associated with posterolateral instability of the elbow

Cubitus Valgus

Lateral physeal growth arrest

Delayed (>12 weeks) or Nonunion

More common in non operative treatment

Fishtail Deformity: persistent gap between lateral condyle and trochlea physes


Late ORIF (>3 weeks)


Tardy Ulnar nerve palsy: seen in valgus malunions