Lateral condyle fractures in children: evaluation of classification and treatment.
OBJECTIVE
To compare intra-operative findings of fractures of the lateral condyle of the humerus in children with existing pre-operative radiographic classification.


METHODS
Prospective, consecutive.


METHODS
Large urban hospital.


METHODS
25 consecutive displaced lateral condyle (humerus fractures) in 25 children diagnosed on biplanar radiographs.


METHODS
Open reduction and internal fixation through a lateral approach to the elbow.


METHODS
Anatomic variations of the lateral condyle of the distal humerus based upon intra-operative observations; comparison of findings with pre-operative radiographic classification.


RESULTS
Three anatomic types were identified: 1) nine fractures exited on the medial side of the capitellum in the capitello-trochlear groove (36%), 2) eleven fractures exited beyond the capitello-trochlear groove through the trochlear epiphysis (44%), and 3) five fractures extended across the physis medially (20%). No fracture appeared to transverse the ossified portion of the capitellum (Milch Type I). The Milch anatomic classification was found to be inaccurate in 52% of the fractures.


CONCLUSIONS
Intraoperative findings did not correlate with the presumed preoperative radiographic diagnosis in the majority of cases. A heightened awareness of the limitations of this traditional classification system is required for operative decision.
Mirsky
E C
EC
Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10029, USA.
Karas
E H
EH
Weiner
L S
LS
D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D000092464:Elbow Injuries