Evaluation and management of condylar elbow fractures in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This review discusses the evaluation and management of condylar elbow fractures in children. The evaluation and management of supracondylar, epicondylar, and transphyseal elbow fractures are discussed separately. (See "Evaluation and management of supracondylar fractures in children" and "Epicondylar and transphyseal elbow fractures in children".)
Lateral condylar fractures account for up to 15 percent of all elbow fractures in children [1-3]. The peak age of injury is six years . Medial condylar elbow fractures are rare (<1 percent of all elbow fractures in children) and typically occur in children older than eight years of age in whom the medial condylar epiphysis is seen radiographically .
The general anatomy of the elbow is discussed separately. (See "Elbow anatomy and radiographic diagnosis of elbow fracture in children", section on 'Pertinent anatomy'.)
The lateral and medial condyles of the elbow extend distally from the relatively weak supracondylar region (figure 1). Fracture through the lateral condyle can extend into the capitellum, disturbing the articulation with the radial head, or into the unossified trochlea, resulting in elbow instability (figure 2). Medial condylar elbow fractures are the mirror image of lateral condylar fractures with the fracture line typically ending in the trochlear notch (figure 3). When displacement of the medial condyle occurs, the elbow joint also becomes unstable.
Ulnar nerve paresthesia is sometimes seen acutely in patients with medial condylar elbow fractures. Otherwise, condylar elbow fracture patterns do not usually lead to significant neurovascular impingement.
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- PERTINENT ANATOMY
- MECHANISM OF INJURY
- PHYSICAL FINDINGS
- RADIOGRAPHIC FINDINGS
- Lateral condylar fracture
- Medial condylar fracture
- INITIAL TREATMENT
- Analgesia and immobilization
- Orthopedic consultation
- Definitive care
- - Lateral condylar fractures
- - Medial condylar fractures
- FOLLOW-UP CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS