Paediatric lateral condyle fracture with a posterolateral elbow dislocation: an atypical injury in a preadolescent

Abstract

Paediatric lateral condyle fractures of the distal humerus are common but a concomitant elbow dislocation is rare. Typically, paediatric orthopaedic surgeons will treat lateral condyle fractures with pin or metaphyseal single-screw fixation and supplementary immobilisation for several weeks. These techniques sacrifice the early stability and mobilisation necessary to avoid stiffness after a complex elbow fracture-dislocation. We present an 11-year-old boy who sustained a traumatic posterolateral elbow dislocation with lateral condyle and coronoid fractures. Due to advanced skeletal age, both paediatric and adult treatment principles were applied to this rare injury. After initial closed reduction, open reduction and internal fixation of the distal humerus lateral condyle with divergent partially threaded compression screws was performed. Motion was initiated in 2 weeks and the patient regained almost full motion by 3 months. At 1.5-year follow-up, the affected limb carrying angle was unaffected and the patient had no functional limitations.

Keywords: elbow fracture; elbow instability; orthopaedic and trauma surgery; orthopaedics.

Figure 1

Initial anteroposterior and lateral radiographs of right elbow in the emergency department.

Figure 2

Postclosed reduction lateral radiograph of right elbow in emergency department.

Figure 3

Postreduction CT scan of right elbow in posterior plaster splint.

Figure 4

Intraoperative anteroposterior and lateral fluoroscopic images of right elbow.

Figure 5

Patient at 9 weeks postoperative demonstrating elbow arc of motion.

Figure 6

Nine-week anteroposterior and lateral radiographs of right elbow.