pediatric - humeral lateral condylar fracture

Complication after close treatment for lateral conylar or supracondylar
．Supracndylar fx: intact ROM, correctable cubitus varus
．Lateral condylar fx: impaired ROM

Classification of humeral lateral condylar fx

．Pull-off mechanism
．Pull strength from LCL complex

Classification: Milch, Jakob
．Milch I: no through ossification center of capitellum, to trochlea
．Milch II: through ossification center of capitelleum, to capitellum-radio joint

Jakob classification
1.fracture, intact medial cartilage
2.disruption of medial cartilage, minimally displaced
3.rotated and displaced fragment

initial of fracture area: posterolateral cortex

soft tissue over humeral lateral condyle
．LCL complex
．ECRL
．Brachioradialis

X-ray
．Important to differential Jakob stage I & II
．True AP, true LAT, Oblique view

Definition of minimal displacement
．2 mm
．< 2mm, stable, percutaneous pinning
．> 2mm, unstable, ORIF

ORIF:
．Crossed or parallel two pinning
．Kocher's approach

Complications of nonunion
．progressive displacement → cubitus valgus → tardy ulnar nerve palsy

Complications
Biological VS technical

1．Lateral spur formation
Fracture → over dissecting during operation → displaced periosteum → new bone formation

Fishtail deformity
．Premature closure of distal humeral physis
．osteonecrosis

Nerve injury
．acute stage: radial nerve, or posterior interosseous nerve injury
．late stage: tardy ulnar nerve palsy → malunion or nonunion related cubitus valgus. Treated with anterior nerve transposition