Fracture Guideline Index
See also:
Lateral condyle fracture of the humerus - Emergency Department
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How often should these fractures be followed up in fracture clinics?
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What should I review at each appointment?
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What are the potential complications associated with this injury?
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When should I refer for an orthopaedic consultant opinion?
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What are the indications for discharge?
1. How often should these fractures be followed up in fracture clinics?
Table 1: Recommended follow-up schedule for lateral condyle fractures of the humerus.
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Fracture type
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First appointment
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Subsequent review appointments
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Discharge advice to parents
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Undisplaced
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Within 1 week post-immobilisation with x-ray out of backslab
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At 6 weeks post-immobilisation with x-ray out of backslab. Mobilise and check for union
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A growth arrest causing angular growth problems in the elbow can occur and parents should be advised to watch for this in the longer term
Advise parents that it will take 3 months for return to contact sports or rough play
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Minimally displaced (
<2 mm)
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If percutaneous wires present, review at 3 weeks post-operative with x-ray, change of backslab and removal of percutaneous wires
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At 6 weeks post-operative with x-ray (check for union). Removal of backslab
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As above
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Displaced (>2 mm)
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3-4 weeks post-operative with x-ray and change of backslab and removal of percutaneous wires if present
RCH practice: Usually wires and screws are buried because of slower union rates
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At 6 weeks post-operative with x-ray (check for union). Removal of backslab
Transfer to a consultant-led clinic for consideration of subsequent metalware removal and follow-up regarding growth disturbance (approx. 6 months)
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Child will be seen in consultant led clinic for consideration of metalware removal and follow-up regarding growth disturbance (approx. 6 month review). Some may need long-term follow-up to monitor for growth disturbance
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2. What should I review at each appointment?
Check for displacement (especially with minimally and undisplaced fractures), signs of radiographic union (new callus formation along periosteal line) occurring from three weeks post-fracture.
3. What are the potential complications associated with this injury?
Nonunion and delayed union
Overgrowth at the lateral condyle can cause an unsightly bump on the outside of the elbow
Elbow deformity: growth disturbance can occur resulting in angular growth of the elbow. Typically this results in the valgus shape to the elbow. This can become progressively worse causing a late injury to the ulnar nerve (tardy ulnar nerve palsy)
Elbow stiffness
Neurological injuries can result from the fracture itself or the treatment. The great majority of the neurological injuries resolve with time
4. When should I refer for an orthopaedic consultant opinion?
Indications for a consultant orthopaedic surgeon opinion are:
- orthopaedic fixation and decision regarding removal
- long-term follow-up for growth disturbance, i.e. 6 months
5. What are the indications for discharge?
- No pain
- Non-tender
- Normal/near normal ROM
- Union of lateral condyle on x-ray (callus evident on lateral and AP x-rays)
- No growth disturbance by six months post-injury
References (Outpatient setting)
Beaty JH, Kasser JR. The elbow: Physeal fractures, apophyseal injuries of the distal humerus, avascular necrosis of the trochlea, and T-condylar fractures. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.533-93.
Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Ortho Surg 2011; 19: 350–58.
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Content developed by Victorian Paediatric Orthopaedic Network.
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