1. Lateral Condylar Fractures
5th Semi Annual POSNA/SLAOTI/EPOS
(Tri Continental) Pediatric Orthopedic Surgery Symposium
Sao Paulo, Brazil
October 11-14, 2017
Lateral Condylar Fractures
Perry L. Schoenecker, M.D.
St. Louis Shriners, St. Louis Children’s & Barnes Hospitals, Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA

2. Lateral Condylar Fractures No Conflicts, No Disclosures
Jacob I
Perry L. Schoenecker, M.D.
No Conflicts, No Disclosures

3. Lateral Condyle Fractures
~15 % of all elbow fractures

4. Lateral Condyle Fractures
~15 % of all elbow fractures
Second to Supracondylar

5. Mechanism – Pull Off

6. Varus Pronation Distraction
Pull Off

7. Varus Pronation Distraction
Pull Off

8. Classification
JACOB
JBJS 57B, 1975
SONG

9. Classification
JACOB
JBJS 57B, 1975
SONG
JBJS (A) 90, 2008

10. Jacob I
< 2mm 1 2 3 4 5
SONG

11. Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement
Jacob I
< 2mm
Immobilize ≥ 4weeks → F/U until healed

12. Displacement ~ 2mm
Medial Oblique

13. Tx options: long arm cast or reduction, pinning & cast
Jacob I 1 4 5 2 3
SONG
Tx options: long arm cast or reduction, pinning & cast

14. Closed reduction and k-wire stabilization

15. Closed reduction pinning and arthrogram
Jacob II
2-4mm
Closed reduction pinning and arthrogram
Tanane, elias

16. “Notable Displacement” Scheduled for open reduction
Casey, Adrianne A’gram, stable, type II, CR
“Notable Displacement”
Scheduled for open reduction

17. Very stable in OR, so closed reduction & k-wire fixation
Arthrogram shows condylar surface reduced
Casey, Adrianne A’gram, stable, type II, CR

18. MUST ANATOMICALLY Reduce
Notably displaced
Post pinning w/o a satisfactory reduction  𝑩𝑨𝑫 𝑰𝑫𝑬𝑨, 𝐧𝐨𝐰 𝐩𝐫𝐨𝐛𝐥𝐞𝐦𝐚𝐭𝐢𝐜 𝐧𝐨𝐧 𝐮𝐧𝐢𝐨𝐧

19. Completely Displaced
Jacob III

20. Anatomically reduce & stabilize

21. Lateral Condylar Fxs - Surgical Approach
– Curved mid-lateral 5-6cm
– Dissect anteriorly - not posteriorly
Yes No

22. Stage III Lateral Condyle Fx --- ORIF
Treatment
Stage III Lateral Condyle Fx --- ORIF
Headlight
Tourniquet

23. Stage III Lateral Condyle Fx --- ORIF
Treatment
Stage III Lateral Condyle Fx --- ORIF
Exposure
Reduction/Fixation

24. Stage III Fx --- ORIF Stabilize Stabilize Anatomically reduce
Treatment
Stage III Fx --- ORIF
Stabilize
Stabilize
Anatomically reduce

25. Stage III Fx --- ORIF
Stabilize
Verify Reduction

26. Stage III Fx --- ORIF

27. Stage III Fx --- ORIF 3 pins may be necessary
Scott, Cassie Lateral condylar stage , ORIF R lateral condylar fx

28. Healing may be slow to occur
s/p 8 wks of cast
Painful Delayed Union

29. Delayed / Non Union  Needs reduction and compression

31. Compression/stability Delayed/non-union  stabilize as is
4 mos post ORIF painful
Compression/stability
Philpot, jacob
Delayed/non-union  stabilize as is

32. Lat Condylar FXs – Take Home Message
Follow-up until HEALED
Slight displacement → CR, a’gram & pin
• Displacement &/or instability → ORIF
(must SEE THE JOINT)
Delayed/non-union → STABILIZE typically as is

33. Obrigado
Thank you

34. Immobilize ≥ 4weeks → F/U until healed
Minimal Displacement
~ 2mm
Immobilize ≥ 4weeks → F/U until healed