In this section
Lateral condyle fracture of the humerus - Emergency Department
Table 1: Recommended follow-up schedule for lateral condyle fractures of the humerus.
Subsequent review appointments
Discharge advice to parents
Within 1 week post-immobilisation with x-ray out of backslab
At 6 weeks post-immobilisation with x-ray out of backslab. Mobilise and check for union
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
Minimally displaced (
If percutaneous wires present, review at 3 weeks post-operative with x-ray, change of backslab and removal of percutaneous wires
At 6 weeks post-operative with x-ray (check for union). Removal of backslab
Displaced (>2 mm)
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
Transfer to a consultant-led clinic for consideration of subsequent metalware removal and follow-up regarding growth disturbance (approx. 6 months)
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
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.
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)
Neurological injuries can result from the fracture itself or the treatment. The great majority of the neurological injuries resolve with time
Indications for a consultant orthopaedic surgeon opinion are:
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.